从平板运动试验（TET）的角度，探讨不同经皮冠状动脉介入术（PCI）血运重建策略对于多支病变冠心病患者运动耐量及心肌缺血的影响。

选取北京大学人民医院2014年8月至2016年6月经冠状动脉造影证实多支病变，行PCI并完成TET的116例冠心病患者，根据血运重建程度分为完全血运重建组（CR组，56例）及不完全血运重建组（ICR组，60例）。收集两组患者一般情况［年龄、性别、体质量指数（BMI）、吸烟情况］、合并疾病、服药情况、冠心病病史及病变情况、TET 1周内超声心动图所示射血分数以及TET结果等资料。对CR组和ICR组患者：对年龄，BMI，射血分数，TET中静息心率、静息收缩压、静息舒张压、峰值心率、峰值收缩压、峰值舒张压等数据采用独立样本t检验；对TET距离血运重建时间，血运重建前后Gensini评分，TET中Bruce分级、运动时间、最大代谢当量、ST段下降程度、ST段下降持续时间、最早出现ST段下降的Bruce分级、Duke评分等数据采用Mann-Whitney U检验；对患者中男性、吸烟者、合并疾病、用药情况、心肌梗死史、三支病变、左主干病变、前降支病变、回旋支病变、右冠状动脉病变、心肌桥等的分布情况，TET中ST段水平或下斜型下降≥0.1 mV、提前中止TET、ST段下降形态、胸痛、Duke评分分级等的分布情况采用χ²检验。

CR组和ICR组两组患者一般临床情况（包括性别、年龄、BMI、吸烟情况、合并疾病、用药情况以及射血分数等）比较差异均无统计学意义（P均>0.05）。CR组与ICR组患者冠心病病史及冠状动脉病变情况：与CR组相比，ICR组患者三支病变比例、前降支病变比例、回旋支病变比例以及血运重建后Gensini评分均较高，差异具有统计学意义（51.8% vs 81.7%，χ²=11.741，P=0.001；90.2% vs 98.5%，χ²=4.436，P=0.035；78.6% vs 93.3%，χ²=5.308，P=0.021；［5（0，14）vs 23（12，36），Z=-5.268，P<0.001]；其余资料（包括心肌梗死史比例、TET距离血运重建的时间、左主干病变比例、右冠状动脉病变比例、心肌桥比例及血运重建前Gensini评分）两组间差异无统计学意义（P均>0.05）。CR组及ICR组患者TET结果：两组患者均可达到Bruce 3（2，3）级，两组患者运动时间、TET阳性率、Duke评分以及TET其他各项参数差异均无统计学意义（P均>0.05）。

在多支病变接受PCI的冠心病患者，ICR患者的运动耐量、心肌缺血情况及Duke评分等均不逊于CR患者。

To explore the effect of different percutaneous coronary intervention (PCI) revascularization strategies on exercise tolerance and myocardial ischemia in patients with coronary multivessel disease from the point of view of treadmill exercise testing (TET).

One hundred and sixteen coronary multivessel disease patients who underwent PCI revascularization and TET from August 2014 to June 2016 were studied. The patients were divided into either a complete revascularization group (CR group; n=56) or an incomplete revascularization group (ICR group; n=60). Clinical manifestations, combined diseases, medications, coronary heart disease status, ultracardiographic data, and TET data of these patients were collected and analyzed. The independent samples t-test was used to analyze the data of age, body mass index, ejection fraction, resting heart rate, resting systolic pressure, resting diastolic pressure, peak heart rate, peak systolic pressure, and peak diastolic pressure. The Mann-Whitney U-test was used to analyze the data of duration from revascularization to TET, Gensini score before and after revascularization, Bruce grade, exercise time, maximum metabolic equivalent, degree and duration of ST-segment depression, Bruce grade in the presence of ST-segment depression, and Duke score. The χ² test was used to analyze the distribution of males, smokers, complications, medications, history of myocardial infarction, three-vessel lesions, left main lesion, anterior descending artery lesion, circumflex artery lesion, right coronary artery lesion, myocardial bridge, ST segment level or descending depression≥0.1 mV, early termination of TET, ST segment depression, chest pain, and Duke grade.

The common clinical stootus between the CR group and ICR group had no significant difference (P>0.05). Compared with the CR group, the ICR group had significantly higher proportions of three-vessel lesion (51.8% vs 81.7%, χ²=11.741, P=0.001), anterior descending artery lesion (90.2% vs 98.5%, χ²=4.436, P=0.035), and left circumflex artery lesion (78.6% vs 93.3%, χ²=4.436, P=0.021) as well as higher Gensini score after revascularization [5 (0,14) vs 23 (12, 36), Z=-5.268, P<0.001]. The patients in both groups could reach Bruce 3 (2,3) level during TET. No significant difference was observed in the positive rate of TET, Duke score, or other TET data between the two groups.

For coronary multivessel disease patients after PCI, the TET results in patients undergoing incomplete revascularization are not inferior to those in patients undergoing complete revascularization.