探讨行介入治疗的STEMI患者在院期间死亡事件的危险因素
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摘要
目的 :探讨行介入治疗的急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者在院期间死亡事件的危险因素。方法 :回顾性分析2016年1月～2018年1月我院收治行介入治疗的280例STEMI患者的临床相关参数,根据患者在院治疗期间临床转归分为死亡组(n=57)及存活组(n=223),比较两组患者临床参数的差异性,应用Logistic回归分析及ROC曲线评估各临床参数与在院期间死亡事件的关系。结果 :经过单因素及多因素Logistic回归分析明确cTnI、MPV、年龄、hs-CRP以及NT-proBNP与STEMI患者在院期间死亡事件密切相关,其优势比(OR)(95%CI)分别为1.71(1.31～2.22)、1.96(1.55～2.49)、1.06(1.01～1.10)、3.45(1.42～8.37)及1.32(1.12～1.90),此外,cTnI是预测在院期间死亡事件的最强烈因子,其预测价值最高,ROC曲线下面积(AUC)(95%CI)为0.86(0.81～0.93),P值均小于0.05。结论 :cTnI、MPV、年龄、hs-CRP以及NT-proBNP是STEMI患者介入治疗后在院期间发生死亡事件的独立危险因素。
Objective To explore risk factors for in-hospital mortality for ST-elevation myocardial infarction(STEMI) patients with interventional therapy. Methods The clinical parameters of 280 STEMI patients who underwent percutaneous coronary intervention(PCI) from January 2016 to January 2018 were retrospectively reviewed. All of them were divided into death group(n=57) and survivor group(n=223) according to clinical prognosis during hospitalization. The parameters were compared between two groups, and logistic regression analysis and ROC curve were used to evaluate the relationship between clinical parameters and in-hospital mortality. Results We found cTnI, MPV, age, hs-CRP and NT-proBNP had a closely relationship with in-hospital mortality, the odds ratio(OR)(95% CI) of them were 1.71(1.31～2.22), 1.96(1.55～2.49), 1.06(1.01～1.10), 3.45(1.42～8.37) and 1.32(1.12～1.90), respectively by using logistic regression analysis, what's more, cTnI is the strongest predictor of death during hospitalization, with the highest predictive value. The area under the ROC curve(AUC)(95% CI) is 0.86(0.81～0.93), and the P values are less than 0.05. Conclusion The independent risk factors for death in STEMI patients during hospitalization were age, cTnI, MPV, hs-CRP and NT-proBNP.
Objective To explore risk factors for in-hospital mortality for ST-elevation myocardial infarction(STEMI) patients with interventional therapy. Methods The clinical parameters of 280 STEMI patients who underwent percutaneous coronary intervention(PCI) from January 2016 to January 2018 were retrospectively reviewed. All of them were divided into death group(n=57) and survivor group(n=223) according to clinical prognosis during hospitalization. The parameters were compared between two groups, and logistic regression analysis and ROC curve were used to evaluate the relationship between clinical parameters and in-hospital mortality. Results We found cTnI, MPV, age, hs-CRP and NT-proBNP had a closely relationship with in-hospital mortality, the odds ratio(OR)(95% CI) of them were 1.71(1.31～2.22), 1.96(1.55～2.49), 1.06(1.01～1.10), 3.45(1.42～8.37) and 1.32(1.12～1.90), respectively by using logistic regression analysis, what's more, cTnI is the strongest predictor of death during hospitalization, with the highest predictive value. The area under the ROC curve(AUC)(95% CI) is 0.86(0.81～0.93), and the P values are less than 0.05. Conclusion The independent risk factors for death in STEMI patients during hospitalization were age, cTnI, MPV, hs-CRP and NT-proBNP.
引文
[1]国家卫生计生委合理用药专家委员会,中国药师协会.急性ST段抬高型心肌梗死溶栓治疗的合理用药指南[J].中国医学前沿杂志(电子版), 2016, 8(8):25-41.
[2]中国医师协会急诊医师分会,中华医学会心血管病学分会,中华医学会检验医学分会.急性冠脉综合征急诊快速诊疗指南[J].中华急诊医学杂志, 2016, 25(4):397-404.
[3]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要.中国循环杂志, 2016, 31(6):521-528.
[4]Ibanez B, James S, Agewall S, et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation:The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2018, 39(2):119-177.
[5]范洪起. CKMB、cTnT、cTnl指标变化与急性心肌梗死范围的相关性研究[J].海南医学院学报, 2014, 20(5):602-604.
[6]王辉,刘震宇,张抒扬,等.高龄急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的近期预后[J].中华老年心腑血管病杂志, 2015, 17(10):1028-1032.
[7]叶绍东,祁雨,孙中伟,等.75岁以上老年急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗长期死亡危险因素分析[J].中国介入心脏病学杂志, 2018, 26(5):268-273.
[8]Takeuchi T, Ishii Y, Kikuchi K, et al. Ischemic preconditioning effect of prodromal angina is attenuated in acute myocardial infarction patients with hypertensive left ventricular hypertrophy[J]. Circ J, 2011, 75(5):1192-1199.
[9]郑名辉,赵利军,郭政.糖尿病患者围术期血小板活性的变化[J].中华麻醉学, 2017, 37(8):918-920.
[10]符明昌,周莲,羊文芳,等.血清NT-proBNP、hs-TnT及hs-CRP水平与急性心肌梗死的相关性研究[J].海南医学, 2016, 27(18):2952-2955.
[11]刘洪军,杨猛,张开忠. NT-proBNP、CysC和PCT对急性冠脉综合征患者预后评估的应用价值[J].广西医科大学学报, 2017, 34(8):1145-1149.
[2]中国医师协会急诊医师分会,中华医学会心血管病学分会,中华医学会检验医学分会.急性冠脉综合征急诊快速诊疗指南[J].中华急诊医学杂志, 2016, 25(4):397-404.
[3]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要.中国循环杂志, 2016, 31(6):521-528.
[4]Ibanez B, James S, Agewall S, et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation:The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2018, 39(2):119-177.
[5]范洪起. CKMB、cTnT、cTnl指标变化与急性心肌梗死范围的相关性研究[J].海南医学院学报, 2014, 20(5):602-604.
[6]王辉,刘震宇,张抒扬,等.高龄急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的近期预后[J].中华老年心腑血管病杂志, 2015, 17(10):1028-1032.
[7]叶绍东,祁雨,孙中伟,等.75岁以上老年急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗长期死亡危险因素分析[J].中国介入心脏病学杂志, 2018, 26(5):268-273.
[8]Takeuchi T, Ishii Y, Kikuchi K, et al. Ischemic preconditioning effect of prodromal angina is attenuated in acute myocardial infarction patients with hypertensive left ventricular hypertrophy[J]. Circ J, 2011, 75(5):1192-1199.
[9]郑名辉,赵利军,郭政.糖尿病患者围术期血小板活性的变化[J].中华麻醉学, 2017, 37(8):918-920.
[10]符明昌,周莲,羊文芳,等.血清NT-proBNP、hs-TnT及hs-CRP水平与急性心肌梗死的相关性研究[J].海南医学, 2016, 27(18):2952-2955.
[11]刘洪军,杨猛,张开忠. NT-proBNP、CysC和PCT对急性冠脉综合征患者预后评估的应用价值[J].广西医科大学学报, 2017, 34(8):1145-1149.