ST段抬高型心肌梗死直接经皮冠状动脉介入术治疗预后危险因素及危险分层
|
摘要
目的探讨行直接经皮冠状动脉介入术(primary percutaneous coronary intervention, pPCI)治疗的ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者院内主要心血管不良事件(major adverse cardiovascular events, MACEs)发生的危险因素并进行危险分层。方法行pPCI治疗的STEMI患者128例,依据术后10 d是否发生MACEs分为MACEs组62例,非MACEs组66例。记录患者一般资料,多因素logistic回归分析MACEs发生的危险因素,并根据OR值对危险因素进行危险分层。结果 MACEs组年龄、心率、ST段抬高总幅度、平均ST段抬高幅度,以及饮酒、下壁心肌梗死、Killip分级Ⅱ～Ⅲ级比率与非MACEs组比较差异均有统计学意义(P<0.05),体质量、左室射血分数等与非MACEs组比较差异均无统计学意义(P>0.05);年龄>60岁(OR=4.45,95%CI:1.65～12.04,P=0.003),入院时心率≤67次/min(OR=3.47, 95%CI:1.25～9.63,P=0.017)、ST段抬高总幅度≥1.15 mV (OR=10.08,95%CI:2.64～38.53,P=0.001)、下壁心肌梗死(OR=7.78,95%CI:2.11～28.69,P=0.002)、Killip分级Ⅱ级(OR=4.21, 95%CI:2.96～6.32,P<0.001)、Killip分级Ⅲ级(OR=8.38, 95%CI:4.56～13.53,P<0.001)是院内发生MACEs的危险因素;危险分层结果显示,高风险组院内MACEs发生率(86.54%)高于低风险组(22.37%)(P<0.05)。结论高龄(>60岁)、入院时心率(≤67次/min)、Killip分级Ⅱ～Ⅲ级、下壁心肌梗死及ST段抬高总幅度≥1.15 mV是STEMI患者行pPCI治疗后发生院内MACEs的危险因素,根据危险因素对患者进行危险分层有助于识别危重患者、及时行pPCI治疗。
Objective To investigate the risk factors for major adverse cardiovascular events(MACEs) in patients with ST-segment elevation myocardial infarction(STEMI) treated by primary percutaneous coronary intervention(pPCI) and to create risk stratification model. Methods Totally 128 patients with STEMI treated with pPCI were divided into 62 patients with MACEs(MACEs group) and 66 patients without MACEs(non-MACEs group) according to whether MACEs occurred by day 10 after pPCI. The patient's general data were recorded. Multivariate logistic regression analysis was performed to analyze the risk factors for MACEs, and the risk was stratified according to OR value. Results There were significant differences in the age, heart rate, sum magnitude of ST-segment elevation, average magnitude of ST-segment elevation, alcohol consumption, inferior wall myocardial infarction and Killip class Ⅱ-Ⅲ(P<0.05), and no significant differences in the body mass and left ventricular ejection fraction between two groups(P>0.05). The age>60 years old(OR=4.45, 95% CI:1.65-12.04, P=0.003), heart rate ≤67 beats/min at admission(OR=3.47, 95%CI: 1.25-9.63, P=0.017), sum magnitude of ST-segment elevation ≥1.15 mV(OR=10.08, 95%CI: 2.64-38.53, P=0.001), inferior wall myocardial infarction(OR=7.78, 95%CI: 2.11-28.69, P=0.002), Killip class Ⅱ(OR=4.21, 95%CI: 2.96-6.32, P<0.001) and Killip class Ⅲ(OR=8.38, 95%CI: 4.56-13.53, P<0.001) were the risk factors for in-hospital MACEs. Risk stratification results showed that the incidence of MACEs was significantly higher in high-risk group(86.54%) than that in low-risk group(22.37%)(P<0.05). Conclusion The old age(>60 years), heart rate ≤67 beats/min at admission, Killip class Ⅱ-Ⅲ, inferior wall myocardial infarction and sum magnitude of ST-segment elevation ≥1.15 mV are the risk factors for in-hospital MACEs in patients with STEMI after pPCI. Risk stratification is helpful to identify critically ill patients for pPCI treatment in time.
Objective To investigate the risk factors for major adverse cardiovascular events(MACEs) in patients with ST-segment elevation myocardial infarction(STEMI) treated by primary percutaneous coronary intervention(pPCI) and to create risk stratification model. Methods Totally 128 patients with STEMI treated with pPCI were divided into 62 patients with MACEs(MACEs group) and 66 patients without MACEs(non-MACEs group) according to whether MACEs occurred by day 10 after pPCI. The patient's general data were recorded. Multivariate logistic regression analysis was performed to analyze the risk factors for MACEs, and the risk was stratified according to OR value. Results There were significant differences in the age, heart rate, sum magnitude of ST-segment elevation, average magnitude of ST-segment elevation, alcohol consumption, inferior wall myocardial infarction and Killip class Ⅱ-Ⅲ(P<0.05), and no significant differences in the body mass and left ventricular ejection fraction between two groups(P>0.05). The age>60 years old(OR=4.45, 95% CI:1.65-12.04, P=0.003), heart rate ≤67 beats/min at admission(OR=3.47, 95%CI: 1.25-9.63, P=0.017), sum magnitude of ST-segment elevation ≥1.15 mV(OR=10.08, 95%CI: 2.64-38.53, P=0.001), inferior wall myocardial infarction(OR=7.78, 95%CI: 2.11-28.69, P=0.002), Killip class Ⅱ(OR=4.21, 95%CI: 2.96-6.32, P<0.001) and Killip class Ⅲ(OR=8.38, 95%CI: 4.56-13.53, P<0.001) were the risk factors for in-hospital MACEs. Risk stratification results showed that the incidence of MACEs was significantly higher in high-risk group(86.54%) than that in low-risk group(22.37%)(P<0.05). Conclusion The old age(>60 years), heart rate ≤67 beats/min at admission, Killip class Ⅱ-Ⅲ, inferior wall myocardial infarction and sum magnitude of ST-segment elevation ≥1.15 mV are the risk factors for in-hospital MACEs in patients with STEMI after pPCI. Risk stratification is helpful to identify critically ill patients for pPCI treatment in time.
引文
[1] 高云,阴赪茜,孙涛,等.急性胸痛评分及血清B型脑钠肽对急诊胸痛患者心血管不良事件的预测价值[J].中华实用诊断与治疗杂志,2015,29(1):37-40.
[2] 高晓津,杨进刚,杨跃进,等.中国急性心肌梗死患者心血管危险因素分析[J].中国循环杂志,2015,30(3):206-210.
[3] 中国心血管病报告编写组.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-530.
[4] KILLIP T, KIMBALL J T. Treatment of myocardial infarction in a coronary care unit: a two-year experience with 250 patients[J]. Am J Cardiol,1967,20(4):457-464.
[5] VICENT L, VELáSQUEZ-RODRíQUEZ J, VALERO-MASA M J, et al. Predictors of high Killip class after ST-segment elevation myocardial infarction in the era of primary reperfusion[J]. Int J Cardiol,2017,248:46-50.
[6] GERSHLICK A H, JAMAL NASIR K, KELLY D J, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial[J]. J Am Coll Cardiol,2015,65(10):963-972.
[7] 洪涛.欧洲心脏病学会2017版急性ST段抬高型心肌梗死诊断和治疗指南更新之我见[J].中国介入心脏病学杂志,2017,25(9):483-485.
[8] VERSTEYLEN M O, BEKKERS S C, SMULDERS M W, et al. Performance of angiographic, electrocardiographic and MRI methods to assess the area at risk in acute myocardial infarction[J]. Heart,2012,98(2):109-115.
[9] 双莲,陈凤英,崔晓迎,等.非ST段抬高型急性冠脉综合征患者心电图aVR导联ST段抬高与近期预后的相关性分析[J].现代生物医学进展,2016,16(5):922-925.
[10] 周峥.影响高龄STEMI患者直接PCI近期预后的相关因素分析[J].浙江临床医学,2017,19(7):1225-1227.
[11] ALI M, LANGE S A, WITTLINGER T, et al. In-hospital mortality after acute STEMI in patients undergoing primary PCI[J]. Herz,2017,43(8):741-745.
[12] 申倩南,王东侠,翟恒博,等.性别和年龄对急性ST段抬高型心肌梗死患者住院期间主要不良心脑血管事件的影响[J].中华心血管病杂志,2017,45(4):288-293.
[13] 张新红,李巍,孟四平,等.中青年急性心肌梗死临床发病特点及预防[J].中华实用诊断与治疗杂志,2018,32(6):578-579.
[14] 黄丹,黄鹤,肖亚丽,等.中青年急性心肌梗死猝死患者血液指标特征分析[J].中华实用诊断与治疗杂志,2015,29(6):586-588.
[15] 李华珍,王红,梁文武.急性心肌梗死急诊行经皮冠状动脉介入术中再灌注心律失常的临床研究[J].中华实用诊断与治疗杂志,2009,23(6):608-609.
[16] ZIPES D P. The clinical significance of bradycardic rhythms in acute myocardial infarction[J]. Am J Cardiol,1969,24(6):814-825.
[2] 高晓津,杨进刚,杨跃进,等.中国急性心肌梗死患者心血管危险因素分析[J].中国循环杂志,2015,30(3):206-210.
[3] 中国心血管病报告编写组.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-530.
[4] KILLIP T, KIMBALL J T. Treatment of myocardial infarction in a coronary care unit: a two-year experience with 250 patients[J]. Am J Cardiol,1967,20(4):457-464.
[5] VICENT L, VELáSQUEZ-RODRíQUEZ J, VALERO-MASA M J, et al. Predictors of high Killip class after ST-segment elevation myocardial infarction in the era of primary reperfusion[J]. Int J Cardiol,2017,248:46-50.
[6] GERSHLICK A H, JAMAL NASIR K, KELLY D J, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial[J]. J Am Coll Cardiol,2015,65(10):963-972.
[7] 洪涛.欧洲心脏病学会2017版急性ST段抬高型心肌梗死诊断和治疗指南更新之我见[J].中国介入心脏病学杂志,2017,25(9):483-485.
[8] VERSTEYLEN M O, BEKKERS S C, SMULDERS M W, et al. Performance of angiographic, electrocardiographic and MRI methods to assess the area at risk in acute myocardial infarction[J]. Heart,2012,98(2):109-115.
[9] 双莲,陈凤英,崔晓迎,等.非ST段抬高型急性冠脉综合征患者心电图aVR导联ST段抬高与近期预后的相关性分析[J].现代生物医学进展,2016,16(5):922-925.
[10] 周峥.影响高龄STEMI患者直接PCI近期预后的相关因素分析[J].浙江临床医学,2017,19(7):1225-1227.
[11] ALI M, LANGE S A, WITTLINGER T, et al. In-hospital mortality after acute STEMI in patients undergoing primary PCI[J]. Herz,2017,43(8):741-745.
[12] 申倩南,王东侠,翟恒博,等.性别和年龄对急性ST段抬高型心肌梗死患者住院期间主要不良心脑血管事件的影响[J].中华心血管病杂志,2017,45(4):288-293.
[13] 张新红,李巍,孟四平,等.中青年急性心肌梗死临床发病特点及预防[J].中华实用诊断与治疗杂志,2018,32(6):578-579.
[14] 黄丹,黄鹤,肖亚丽,等.中青年急性心肌梗死猝死患者血液指标特征分析[J].中华实用诊断与治疗杂志,2015,29(6):586-588.
[15] 李华珍,王红,梁文武.急性心肌梗死急诊行经皮冠状动脉介入术中再灌注心律失常的临床研究[J].中华实用诊断与治疗杂志,2009,23(6):608-609.
[16] ZIPES D P. The clinical significance of bradycardic rhythms in acute myocardial infarction[J]. Am J Cardiol,1969,24(6):814-825.