摘要
目的探讨平均动脉压(MAP)水平对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)后1年内预后的影响。方法选取北部战区总医院自2016年3月至2019年3月收治的接受急诊PCI的2829例AMI患者为研究对象。根据患者术前MAP水平中位数将患者分入A组(MAP<92 mmHg,n=1414)和B组(MAP≥92 mmHg,n=1415)。比较两组患者的临床基线资料、手术资料、围术期用药情况,以及终点事件随访结果。对患者进行1年随访,研究主要终点为是否发生全因死亡,次要终点为缺血事件,包括心源性死亡、卒中、再发心肌梗死。结果B组肌酐清除率、左室射血分数及合并高血压、既往卒中、非ST段抬高型心肌梗死比例均低于A组,差异有统计学意义(P<0.05)。A组右冠状动脉为罪犯血管的比例高于B组,桡动脉入路、靶血管为左前降支的比例低于B组,差异有统计学意义(P<0.05)。B组血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂、β受体阻滞剂使用比例低于A组,差异有统计学意义(P<0.05)。B组全因死亡、缺血事件、心源性死亡发生率均低于A组,差异有统计学意义(P<0.05)。AMI患者围术期MAP与1年全因死亡发生率呈U型曲线关系,具有显著非线性相关性(P<0.05);当MAP阈值定义为100 mmHg时,全因死亡发生风险最低,以100 mmHg为参考值,无论MAP升高或降低,患者1年内发生全因死亡的风险均体现为上升趋势。结论接受急诊PCI的AMI患者的MAP水平与全因死亡发生率呈非线性相关,维持MAP稳定有助于改善患者预后。
Objective To investigate the effect of mean arterial pressure(MAP)level on the prognosis of acute myocardial infarction(AMI)patients undergoing emergency percutaneous coronary intervention(PCI).Methods A total of 2829 AMI patients who underwent emergency PCI in General Hospital of Northern Theater Command from March 2016 to March 2019 were selected as the research objects.According to the median preoperative MAP level,patients were divided into group A(MAP<92 mmHg,n=1414)and group B(MAP≥92 mmHg,n=1415).The clinical baseline data,surgical data,perioperative medication,and follow-up results of end-point events were compared between the two groups.Patients were followed for 1 year.The primary end point was all-cause death,and the secondary end point was ischemic events,including cardiac death,stroke,and recurrent myocardial infarction.Results The creatinine clearance rate,left ventricular ejection fraction and the proportion of patients with hypertension,previous stroke and non-ST-segment elevation myocardial infarction in group B were than those in group A,and the differences were statistically significant(P<0.05).The proportion of right coronary artery as culprit vessel in group A was higher than that in group B,and the proportion of radial artery approach and target vessel as left anterior descending artery in group A was lower than that in group B,and the differences were statistically significant(P<0.05).The proportion of angiotensin converting enzyme inhibitor/angiotensinⅡreceptor blocker andβ-blocker in group B was higher than that in group A,and the differences were statistically significant(P<0.05).The incidences of all-cause death,ischemic events and cardiac death in group B were lower than those in group A,and the differences were statistically significant(P<0.05).There was a U-shaped curve relationship between perioperative MAP and 1-year all-cause mortality in AMI patients,with significant nonlinear correlation(P<0.05).When the MAP threshold was defined as 100 mmHg,the risk of all-cause death was the lowest.With 100 mmHg as the reference value,the risk of all-cause death in patients within 1 year showed an upward trend regardless of MAP increase or decrease.Conclusion MAP level is nonlinearly correlated with the incidence of all-cause mortality in AMI patients undergoing emergency PCI.Maintaining stable MAP is helpful to improve the prognosis of patients.
作者
程茗慧
裘淼涵
常艳
齐艳萍
张效林
CHENG Ming-hui;QIU Miao-han;CHANG Yan;QI Yan-ping;ZHANG Xiao-lin(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《临床军医杂志》
CAS
2022年第11期1101-1104,共4页
Clinical Journal of Medical Officers
基金
辽宁省科学技术基金(2019-ZD-1060)
关键词
急性心肌梗死
平均动脉压
全因死亡
急诊
经皮冠状动脉介入治疗
预后
Acute myocardial infarction
Mean arterial pressure
All-cause death
Emergency
Percutaneous coronary intervention
Prognosis
