摘要
目的探讨前壁急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者直接经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后发生主要不良心血管事件(major adverse cardiovascular events,MACE)的影响因素。方法前壁STEMI患者92例,均行直接PCI治疗,术后12~24h行心肌超声造影测量心肌血管床容积(A)、心肌血流速度(β)、心肌血流量(A×β)及左室射血分数。PCI后随访6个月,13例发生MACE者为MACE组,79例未发生MACE者为无MACE组。比较2组临床资料、生化指标、PCI治疗相关资料,多因素logistic回归分析前壁STEMI患者PCI后发生MACE的影响因素。结果MACE组PCI前血清B型脑钠肽[(413.00±101.72)ng/L]、PCI次日肌钙蛋白I峰值[(66.20±17.89)μg/L]较无MACE组[(295.80±155.77)ng/L、(42.68±22.73)μg/L]高(P<0.05)。2组年龄,男性比率,吸烟比率,有高血压、糖尿病、冠心病家族史比率以及PCI次日血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平比较差异无统计学意义(P>0.05)。MACE组A[(6.39±0.75)dB]、β[(0.45±0.06)/s]、A×β[(2.82±0.51)dB/s]、左室射血分数[(45.00±2.92)%]较无MACE组[(7.38±0.76)dB、(0.51±0.07)/s、(3.79±0.72)dB/s、(50.90±6.00)%]低(P<0.05)。MACE组PCI后心肌灌注分级3级比率(46.15%)较无MACE组(69.62%)低,发病至再灌注时间[(368.26±60.35)min]较无MACE组[(293.23±99.63)min]长(P<0.05)。多因素logistic回归分析结果显示,A×β(OR=0.047,95%CI:0.003~0.729,P=0.029)、肌钙蛋白I峰值(OR=1.069,95%CI:1.001~1.141,P=0.047)是前壁STEMI患者PCI后6个月发生MACE的影响因素。结论前壁STEMI患者PCI后6个月发生MACE与PCI次日肌钙蛋白I峰值及心肌血流量有关。
Objective To investigate the risk factors for major adverse cardiovascular events(MACE)after primary percutaneous coronary intervention(PCI)in patients with anterior acute ST-elevation myocardial infarction(STEMI).Methods Ninety-two patients with anterior STEMI underwent primary PCI and myocardial contrast echocardiography 12 to 24hafter PCI to measure myocardial vascular volume(A),myocardial blood flow velocity(β),myocardial blood flow(A×β)and left ventricular ejection fraction.The patients were divided into MACE group(n=13)and non-MACE group(n=79)according to the 6-month follow-up results.The clinical data,biochemical parameters and PCI treatment were compared between two groups.The risk factors for MACE after PCI were analyzed by multivariate logistic regression in anterior STEMI patients.Results The brain natriuretic peptide and peak cardiac troponin I on the first day after PCI were higher in MACE group((413.00±101.72)ng/L,(66.20±17.89)μg/L)than those in non-MACE group((295.80±155.77)ng/L,(42.68±22.73)μg/L)(P<0.05).There were no significant differences in the age,male ratio,smoking rate,percentages of hypertension,diabetes and coronary heart disease,as well as the levels of total cholesterol,triacylglycerol,low-density lipoprotein cholesterol and high-density lipoprotein cholesterol on the first day after PCI between two groups(P>0.05).The values of A((6.39±0.75)dB),β((0.45±0.06)/s),A×β((2.82±0.51)dB/s)and left ventricular ejection fraction((45.00±2.92)%)were lower in MACE group than those in non-MACE group((7.38±0.76)dB,(0.51±0.07)/s,(3.79±0.72)dB/s,(50.90±6.00)%)(P<0.05).The rate of post-PCI TIMI myocardial perfusion grade 3was lower in MACE group(46.15%)than that in non-MACE group(69.62%),and the time from onset to reperfusion was longer in MACE group((368.26±60.35)min)than that in non-MACE group((293.23±99.63)min)(P<0.05).Multivariate logistic regression analysis showed that A×β(OR=0.047,95%CI:0.003-0.729,P=0.029)and peak cardiac troponin I(OR=1.069,95%CI:1.001-1.141,P=0.047)were the risk factors for MACE after PCI in anterior STEMI patients.Conclusion MACE in anterior STEMI patients is correlated with peak cardiac troponin I and myocardial blood flow volume 6months after PCI.
作者
刘雅婷
谷新顺
张芳
赵甲彧
LIU Yating;GU Xinshun;ZHANG Fang;ZHAO Jiayu(Department of Ultrasound,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China;Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang050000,China;Department of Cardiology,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China)
出处
《中华实用诊断与治疗杂志》
2020年第5期505-508,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
秦皇岛市重点研发计划科技支撑项目(201805A059)。
关键词
急性ST段抬高型心肌梗死
前壁
直接经皮冠状动脉介入术
主要不良心血管事件
心肌超声造影
acute ST-segment elevation myocardial infarction
anterior
primary percutaneous coronary intervention
major adverse cardiovascular event
myocardial contrast echocardiography
