老年女性心肌梗死患者发病至给予双联抗血小板治疗时间与预后的相关性研究
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摘要
目的分析老年女性急性心肌梗死(AMI)发病至入院首次给予双联抗血小板治疗的不同时间的临床预后情况,探讨其时间差(ΔT)与患者预后之间的关系。方法选择老年女性AMI患者114例,根据患者首次发病时间到给予双联抗血小板治疗的ΔT中位数188min为界值,将患者分为≤188min组和>188min组,每组57例,比较分析2组发生心律失常、心肌梗死后心绞痛、心力衰竭及死亡等主要不良心血管事件(MACE)情况。结果 114例AMI患者中,发生MACE 44例,其中死亡17例,心律失常6例,心肌梗死后心绞痛16例,心力衰竭5例。≤188min组与>188 min组心律失常(7.0%vs 3.5%),心肌梗死后心绞痛(7.0%vs 21.1%),心力衰竭(7.0%vs1.8%),死亡(15.8%vs 14.0%)比较,差异有统计学意义(P<0.05)。年龄、糖尿病、ΔT、高脂血症、高血压、冠状动脉病变是影响患者不良预后的独立相关因素(P<0.05,P<0.01)。结论尽可能地缩短ΔT,及时进行临床治疗程序,开通罪犯血管,挽救缺血心肌,对预防老年女性AMI患者恶性心血管事件的发生、降低病死率尤其重要。
Objective To analyze the relationship between onset of myocardial infarction(MI)to bivalent antibiotics therapy and outcome in elderly female MI patients.Methods One hundred and fourteen elderly MI patients admitted to our hospital from January 2016 to January 2018 were divided intoΔT≤188 min group(n=57)andΔT>188 min group(n=57)according to the onset of MI to bivalent antibiotics therapy.The major adverse cardiac events(MACE),arrhythmia,angina pectoris,heart failure and death were compared between the two groups.Results MACE occurred in 44 out of the 144 MI patients included in this study.Of the 44 MI patients,17 died,6 were diagnosed with arrhythmia,16 were diagnosed with angina pectoris,5 were diagnosed with heart failure.The incidence of arrhythmia,heart failure and the mortality were significantly higher while the incidence of angina pectoris was significantly lower inΔT≤188 min group than inΔT>188 min group(7.0%vs 3.5%,7.0%vs 1.8%,15.8%vs 14.0%,7.0%vs 21.1%,P<0.05).Age,diabetes,ΔT,hyperlipidemia,hypertension and coronary artery disease were the independent influencing factors for the poor outcome in MI patients(P<0.05,P<0.01).Conclusion TheΔT should be shortened,the MI patients should be timely treated,the criminal blood vessels should be opened,and the ischemic myocardium should be saved in order to prevent the occurrence of severe cardiovascular events and reduce the mortality in elderly MI patients.
Objective To analyze the relationship between onset of myocardial infarction(MI)to bivalent antibiotics therapy and outcome in elderly female MI patients.Methods One hundred and fourteen elderly MI patients admitted to our hospital from January 2016 to January 2018 were divided intoΔT≤188 min group(n=57)andΔT>188 min group(n=57)according to the onset of MI to bivalent antibiotics therapy.The major adverse cardiac events(MACE),arrhythmia,angina pectoris,heart failure and death were compared between the two groups.Results MACE occurred in 44 out of the 144 MI patients included in this study.Of the 44 MI patients,17 died,6 were diagnosed with arrhythmia,16 were diagnosed with angina pectoris,5 were diagnosed with heart failure.The incidence of arrhythmia,heart failure and the mortality were significantly higher while the incidence of angina pectoris was significantly lower inΔT≤188 min group than inΔT>188 min group(7.0%vs 3.5%,7.0%vs 1.8%,15.8%vs 14.0%,7.0%vs 21.1%,P<0.05).Age,diabetes,ΔT,hyperlipidemia,hypertension and coronary artery disease were the independent influencing factors for the poor outcome in MI patients(P<0.05,P<0.01).Conclusion TheΔT should be shortened,the MI patients should be timely treated,the criminal blood vessels should be opened,and the ischemic myocardium should be saved in order to prevent the occurrence of severe cardiovascular events and reduce the mortality in elderly MI patients.
引文
[1]Arslan F,Bongartz L,Ten Berg JM,et al.2017ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:comments from the Dutch ACS Working Group[J].Neth Heart J,2018,26(9):417-421.DOI:10.1007/s12471-018-1134-0.
[2]McCartney PJ,Eteiba H,Maznyczka AM,et al.Effect of lowdose intracoronary alteplase during primary percutaneous coronary intervention on microvascular obstruction in patients with acute myocardial infarction:a Randomized clinical trial[J].JAMA,2019,321(1):56-68.DOI:10.1001/jama.2018.19802.
[3]Paixao AR,Enriquez JR,Wang TY,et al.Risk factor burden and control at the time of admission in patients with acute myocardial infarction:results from the NCDR[J].Am Heart J,2015,170(1):173-179.DOI:10.1016/j.ahj.2015.04.021.
[4]Ambroziak M,Kuryowicz A,Roszkowska-Gancarz M,et al.ESR2gene G1730Avariant is associated with triglycerides level and myocardial infarction in young men but not in women[J].Gene,2018,677:83-88.DOI:10.1016/j.gene.2018.07.048.
[5]Chou LP,Zhao P,Kao C,et al.Women were noninferior to men in cardiovascular outcomes among patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention from Taiwan Acute Coronary Syndrome Full-Spectrum Registry[J].Medicine(Baltimore),2018,97(43):e12998.DOI:10.1097/MD.0000000000 012998.
[6]Khalil P,Kabbach G.Direct oral anticoagulants in addition to antiplatelet therapy for secondary prevention after acute coronary syndromes:a review[J].Curr Cardiol Rep,2019,21(1):5.DOI:10.1007/s11886-019-1088-x.
[7]Guan W,Venkatesh AK,Bai X,et al.Time to hospital arrival among patients with acute myocardial infarction in China:a report from China PEACE prospective study[J].Eur Heart JQual Care Clin Outcomes,2019,5(1):63-71.DOI:10.1093/ehjqcco/qcy022.
[8]Aune E,Endresen K,Fox KA,et al.Effect of implementing routine early invasive strategy on one-year mortality in patients with acute myocardial infarction[J].Am J Cardiol,2010,105(1):36-42.DOI:10.1016/j.amjcard.2009.08.641.
[2]McCartney PJ,Eteiba H,Maznyczka AM,et al.Effect of lowdose intracoronary alteplase during primary percutaneous coronary intervention on microvascular obstruction in patients with acute myocardial infarction:a Randomized clinical trial[J].JAMA,2019,321(1):56-68.DOI:10.1001/jama.2018.19802.
[3]Paixao AR,Enriquez JR,Wang TY,et al.Risk factor burden and control at the time of admission in patients with acute myocardial infarction:results from the NCDR[J].Am Heart J,2015,170(1):173-179.DOI:10.1016/j.ahj.2015.04.021.
[4]Ambroziak M,Kuryowicz A,Roszkowska-Gancarz M,et al.ESR2gene G1730Avariant is associated with triglycerides level and myocardial infarction in young men but not in women[J].Gene,2018,677:83-88.DOI:10.1016/j.gene.2018.07.048.
[5]Chou LP,Zhao P,Kao C,et al.Women were noninferior to men in cardiovascular outcomes among patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention from Taiwan Acute Coronary Syndrome Full-Spectrum Registry[J].Medicine(Baltimore),2018,97(43):e12998.DOI:10.1097/MD.0000000000 012998.
[6]Khalil P,Kabbach G.Direct oral anticoagulants in addition to antiplatelet therapy for secondary prevention after acute coronary syndromes:a review[J].Curr Cardiol Rep,2019,21(1):5.DOI:10.1007/s11886-019-1088-x.
[7]Guan W,Venkatesh AK,Bai X,et al.Time to hospital arrival among patients with acute myocardial infarction in China:a report from China PEACE prospective study[J].Eur Heart JQual Care Clin Outcomes,2019,5(1):63-71.DOI:10.1093/ehjqcco/qcy022.
[8]Aune E,Endresen K,Fox KA,et al.Effect of implementing routine early invasive strategy on one-year mortality in patients with acute myocardial infarction[J].Am J Cardiol,2010,105(1):36-42.DOI:10.1016/j.amjcard.2009.08.641.