目的探讨非梗死相关血管(non-IRA)发生管腔狭窄或慢性完全闭塞性病变(CTO)对急性ST段抬高型心肌梗死(STEMI)患者住院期间预后的影响。方法回顾性分析345例连续入院接受急诊经皮冠状动脉介入治疗(PPCI)的急性STEMI患者的临床资料,根据是否存在冠状动脉多支血管病变或CTO病变进行分组,比较各分组间患者的临床特征、PPCI资料、住院期预后和并发症情况,并采用多因素分析确定住院期间发生主要心血管不良事件(MACE)的独立危险因素。结果 345例急性STEMI患者中共有185例(53.6%)存在冠状动脉多支血管病变,其中110例(31.9%)为双支血管病变,75例(21.7%)为三支血管病变。冠状动脉多支血管病变中合并CTO病变20例(10.8%),占同期PPCI总量的5.8%(20/345)。多支血管病变患者的年龄显著大于单支血管病变患者(P<0.01),原发性高血压、心源性休克、植入≥2枚药物洗脱支架患者的构成比均显著高于单支血管病变患者(P值均<0.05),与单支血管病变患者间梗死相关血管(IRA)构成的差异有统计学意义(P<0.01)。合并CTO病变患者的心力衰竭构成比显著高于不合并CTO病变患者(P<0.05),左心室射血分数显著低于不合并CTO病变患者(P<0.01),与不合并CTO病变患者间术后心肌梗死溶栓试验(TIMI)血流分级构成比的差异有统计学意义(P<0.05)。在住院期间总体患者的MACE发生率为10.4%(36/345),病死率为8.1%(28/345),大出血并发症发生率为1.2%(4/345)。单支血管病变与多支血管病变患者间病死率、再发心肌梗死率、靶血管血运重建率、脑卒中发生率、MACE发生率、大出血发生率的差异均无统计学意义(P值均>0.05),合并CTO病变患者的靶血管血运重建率和MACE发生率均显著高于不合并CTO病变患者(P值均<0.05)。单因素分析结果显示,在住院期间发生MACE的患者中年龄≥75岁、发生心源性休克、发生心力衰竭、术后TIMI血流分级<3级、合并CTO病变的患者构成比均显著高于未发生MACE者(P值分别<0.05或0.01)。多因素分析结果显示,心源性休克(回归系数=2.15,OR=8.58)和术后TIMI血流分级<3级(回归系数=1.97,OR=7.14)是急性STEMI患者住院期间发生MACE的独立危险因素(P值均<0.001),而年龄≥75岁、男性、发生心力衰竭和合并CTO病变均不是STEMI患者在住院期间发生MACE的独立危险因素(P值均>0.05)。结论冠状动脉多支血管病变对行PPCI的STEMI患者的短期预后无明显影响,而合并CTO病变的患者PPCI术后IRA血流恢复差,发生MACE的风险增大,且短期预后不良。冠状动脉造影检查发现急性STEMI患者合并CTO病变是确定高危患者的有力标志。 Objective To investigate the effect of CTO on the prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) during non-infarction-related vascular (non-IRA) stenosis or chronic total occlusion (CTO). Methods The clinical data of 345 consecutive STEMI patients admitted to hospital for acute percutaneous coronary intervention (PPCI) were retrospectively analyzed. The clinical features of patients with different grades of coronary artery were compared according to the presence or absence of coronary artery disease or CTO. , PPCI data, inpatient prognosis and complications, and multivariate analysis was used to identify independent risk factors for major cardiovascular adverse events (MACE) during hospitalization. Results Of the 345 patients with acute STEMI, 185 (53.6%) had coronary multivessel disease, 110 (31.9%) with double vessel disease and 75 (21.7%) with three vessel disease. Twenty patients (10.8%) had CTO lesions in coronary multivessel disease, accounting for 5.8% (20/345) of the total PPCI in the same period. Patients with multivessel disease were significantly older than those with single vessel disease (P <0.01). The constituent ratios of patients with essential hypertension, cardiogenic shock and implantation of two or more drug-eluting stents were significantly higher than those with single-vessel Vascular lesions (P <0.05) were significantly different from those of single vessel disease (P <0.01). The incidence of heart failure in patients with CTO was significantly higher than that in patients without CTO (P <0.05), and the left ventricular ejection fraction was significantly lower than those without CTO (P <0.01) The myocardial infarction thrombolysis test (TIMI) blood flow staging composition difference was statistically significant (P <0.05). The overall incidence of MACE in hospitalized patients was 10.4% (36/345), with a case fatality rate of 8.1% (28/345) and a major bleeding complication rate of 1.2% (4/345). There was no significant difference in mortality, recurrence of myocardial infarction, target vessel revascularization, incidence of stroke, incidence of MACE and incidence of major bleeding between patients with multivessel disease and multivessel disease > 0.05). The rates of target vessel revascularization and MACE in patients with CTO were significantly higher than those without CTO (all P <0.05). Univariate analysis showed that in the hospitalized patients with MACE age ≥ 75 years, cardiogenic shock, heart failure, postoperative TIMI flow grade <3, combined with CTO lesions were significantly higher than the proportion of patients No MACE occurred (p <0.05 or 0.01, respectively). Multivariate analysis showed that the incidence of MACE during hospitalization in patients with acute STEMI was significantly higher for cardiogenic shock (regression coefficient = 2.15, OR = 8.58) and postoperative TIMI grade <3 (regression coefficient = 1.97, OR = 7.14) Risk factors (all P <0.001). However, none of the male patients with heart failure and complicated with CTO were independent risk factors of MACE during hospitalization (P> 0.05). Conclusions Multi-vessel disease of coronary artery has no obvious effect on the short-term prognosis of patients with STEMI who underwent PPCI. In patients with CTO, the blood flow of IRA after PPCI is poor, the risk of MACE increases, and the short-term prognosis is poor. Coronary angiography found that acute STEMI patients with CTO lesions is to determine the strong signs of high-risk patients.