临床研究早期与晚期支架内血栓致4b型急性心肌梗死患者临床结局比较李晓卫1，2，高静1，2，3△，刘寅1，高明东1，肖健勇1摘要：目的 比较早期与晚期支架内血栓（ST）致4b型急性心肌梗死（AMI）患者院内及出院1年生存及预后情况。
方法 入选2015年1月—2018年2月冠状动脉造影确定ST致4b型AMI患者共302例。
根据ST发生时间分为早期ST组（≤30 d）26例和晚期ST组（＞30 d）276例，对比2组患者住院期间及出院1年内的终点事件。
主要研究终点包括心源性死亡和再发AMI；次要研究终点包括靶病变血运重建（TLR）、再次ST、心力衰竭及卒中。
采用Kaplan-Meier法绘制生存曲线并比较2组患者无终点事件发生率；采用Cox回归分析4b型AMI患者发生终点事件的危险因素。
结果 住院期间2组主要研究终点事件发生率差异无统计学意义（7.7% vs. 3.3%，P=0.243）；早期ST组院内心力衰竭发生率高于晚期ST组（11.5% vs. 1.4%，P=0.016），其他次要终点事件发生率差异无统计学意义（P＞0.05）。
平均随访1年，早期ST组主要（20.0% vs. 5.9%，P＜0.05）及次要（36.0% vs. 11.5%，P＜0.05）研究终点事件发生率均高于晚期ST组。
Kaplan-Meier生存分析表明，早期ST组1年累积无主要（P=0.022）及次要（P＜0.001）终点事件发生率均低于晚期ST组。
Cox回归分析表明高血压、冠状动脉旁路移植术史是4b型AMI患者发生主要终点事件的独立危险因素，术中植入主动脉内气囊泵（IABP）、缩短支架内血栓至球囊扩张（ST to B）时间是其发生次要终点事件的独立保护因素。
结论 与晚期ST致4b型AMI患者相比，早期ST患者院内结局相似，长期预后差。
术中植入IABP、缩短ST to B时间可能改善4b型AMI患者预后。
关键词：心肌梗死；主动脉内气囊泵；支架内血栓；靶病变血运重建中图分类号：R541.4 文献标志码：A DOI：10.11958/20230488Comparison of clinical outcomes in patients with 4b acute myocardial infarction caused by earlyand late stent thrombosisLI Xiaowei1, 2, GAO Jing1, 2, 3△, LIU Yin1, GAO Mingdong1, XIAO Jianyong11 Department of Coronary Care Unit, Chest Hospital, Tianjin University, Tianjin 300222, China;2 Tianjin Medical University;3 Tianjin Cardiovascular Diseases Institute△Corresponding Author E-mail:*******************Abstract: Objective To observe and compare in-hospital and 1-year survival and prognosis of patients with 4b acute myocardial infarction (AMI) caused by early and late stent thrombosis (ST). Methods A total of 302 patients with 4b acute myocardial infarction caused by ST were enrolled in this study from January 2015 to February 2018. ST patients were confirmed by coronary angiography. These patients were divided into two groups: the early ST group (n=26) and the late ST group (n=276) according to the time of ST occurrence. Endpoint events during hospitalization and one year of follow up were compared between the two groups of patients. The primary endpoint events included cardiac death and recurrent AMI. The secondary endpoint events included target lesion revascularization (TLR), re-stent thrombosis, heart failure and stroke. The incidence of no endpoint events was compared between two groups of patients by Kaplan and Meier survival analysis. Cox regression analysis was used to analyze risk factors for endpoint events in patients with type 4b AMI. Results There was no significant difference in the incidence of the primary endpoint events during hospitalization between the two groups (7.7% vs.3.3%，P=0.243). The incidence of heart failure was higher in the early ST group than that of the late ST group (11.5%vs.1.4%, P=0.016). There was no significant difference in the incidence rates of other secondary endpoint events between the two groups (P＞0.05). After a mean follow-up of 1 year, the incidence rates of primary endpoint events and the secondary eendpoint events were higher in the early ST group (20.0% vs. 5.9%，P＜0.05 and 36.0% vs. 11.5%，P＜0.01）than that of the late ST group. Kaplan and Meier survival analysis showed that the 1-year cumulative incidences of non-primary (P= 0.022) and non-secondary events (P＜0.001) were lower in the early ST group than those of the late ST group. Cox regression 基金项目：天津市卫健委重点学科项目（TJWJ2022XK032）；天津市卫健委科技基金项目（TJWJ2021MS027）；天津市科技计划项目（22JCZDJC00130）；天津市科委重点项目（20YFZCSY00820）；天津市医学重点建设学科项目（TJYXZDXK-055B） 作者单位：1天津大学胸科医院冠心病监护病房（邮编300222）；2天津医科大学；3天津市心血管病研究所 作者简介：李晓卫（1982），男，副主任医师，主要从事急性心肌梗死相关研究。
