摘要
目的观察接受直接经皮冠状动脉介入治疗(PCI)的急性sT段抬高型心肌梗死(STEMI)患者的术后死亡原因和死亡特征。方法回顾性分析2010年1月至2014年5月于临沂市人民医院接受直接PCI治疗的1213例STEMI患者的临床资料,并进行3~7年随访,记录患者的一般资料、手术资料、死亡时间和死亡原因,分析患者的近远期死亡原因及预测因素。结果共1135例患者完成随访,女性368例(32.4%),年龄(60.83±12.31)岁,随访期间有129例发生死亡。PCI术后2周内,心源性死亡占总死亡的97.4%(38/39);PCI术后2周到1年,心源性死亡占62.1%(18/29);PCI术1年后,心源性死亡占40.9%(25/61),恶性肿瘤死亡占19.7%(12/61),脑卒中死亡占14.8%(9/61)。多因素Cox回归分析表明年龄≥70岁、血清肌酐水平升高、左心室射血分数≤40%、发病一球囊开通时间>360min、心源性休克、三支病变和术后心肌梗死溶栓试验血流<3级是总死亡的独立预测因素。结论STEMI患者直接PCI术后1年内心源性死亡是主要死亡原因,而1年后非心源性死亡是主要死亡原因。提示对于长期存活的STEMI患者,除了冠心病二级预防以外,也应积极关注和干预非心源性的死亡危险因素。
Objective To analyze the causes of death in patients with ST-segment elevation myocardial infarction (STEMI)following primary percutaneous coronary intervention (PCI).Methods The clinical data of I 213patients [845males and 368females,mean age:(60.83±12.31)years] with STEMI who underwent direct PCI in Linyi People's Hospital from January 2010to May 2014and followed-up for 3-7 years were retrospectively analyzed.The causes of death and predictors were analyzed.Results Among 1135 patients,129died during the follow-up.Thirty nine patients died in the first 2weeks and 97.4% (38/39)due to cardiovascular causes;29died between 2weeks and 1year and 62.1%(18/29)due to cardiovascular causes;61died after 1 year and 40.9%(25/61)from cardiovascular causes,19.7%(12/61) from cancer,14.8%(9/61)from stroke.Multivariate Cox regression analysis showed that age ≥70years, increase of serum ereatinine,LVEF≤40%,symptom-to-balloon time>360min,cardiac shock,triple vessel lesion,TIMI blood flow less than grade 3were independent predictors of all death.Conclusion Cardiovascular conditions are the main cause of death in the first year and non-cardiovascular conditions are the main cause of death 1year after primary PCI in patients with STEMI.It is suggested that long-term surviving patients should also pay close attention to non-cardiac risk factors.
作者
王建富
李钦萍
魏延津
Wang Jianfu;Li Qinping;Wei Yanjin(Department of Cardiology,Linyi People's Hospital,Linyi 276003,China;Department of Medical Insurance,Affiliated Hospital of Shandong Medical College,Linyi 276004,China)
出处
《中华全科医师杂志》
2018年第11期910-913,共4页
Chinese Journal of General Practitioners
关键词
心肌梗死
经皮冠状动脉介入治疗
死亡
Myocardial infarction
Percutaneous coronary intervention
Death
