摘要
目的 探讨主动脉内球囊反搏术(IABP)辅助治疗高危急性冠状动脉综合征(ACS)患者住院期间发生主要不良心血管事件(MACE)的影响因素。方法 选择2014年10月~2019年12月青岛市市立医院心脏中心行IABP辅助高危冠状动脉血运重建患者350例,根据住院期间是否发生MACE分为MACE组81例,无MACE组269例。比较2组一般临床资料,采用多因素二元logistic回归分析,ROC曲线分析生物标志物和疾病严重程度评分的临床预测价值,计算曲线下面积(AUC)。结果 MACE组年龄、吸烟、高血压、高脂血症、心源性休克、ST段抬高型心肌梗死、冠状动脉狭窄程度、舒张压、心率、肌酐水平明显高于无MACE组,不稳定性心绞痛、收缩压、LVEF、IABP后CABG和住院时间明显低于无MACE组(P<0.05,P<0.01)。多因素二元logistic回归分析显示,年龄(OR=1.099,95%CI:1.026~1.178,P=0.007)、吸烟(OR=3.175,95%CI:1.250~8.067,P=0.015)、高脂血症(OR=3.430,95%CI:1.453~8.067,P=0.005)、心源性休克(OR=7.047,95%CI:3.174~15.645,P=0.001)、冠状动脉狭窄程度(OR=1.097,95%CI:1.007~1.194,P=0.034)、肌酐(OR=1.008,95%CI:1.002~1.013,P=0.004)是IABP辅助高危ACS患者发生MACE的独立危险因素,LVEF(OR=0.897,95%CI:0.850~0.947,P=0.001)是发生MACE的保护因素。年龄、吸烟、高脂血症、冠状动脉狭窄程度、心源性休克、肌酐、LVEF预测MACE的AUC分别为0.669、0.602、0.722、0.627、0.846、0.789、0.168。结论 IABP辅助高危ACS患者通过药物及手术尽早解除冠状动脉狭窄,提高LVEF,避免心源性休克发生,是降低MACE风险的有效途径。
Objective To investigate the influencing factors for major adverse cardiovascular events(MACE) in patients with high-risk acute coronary syndrome(ACS) undergoing intra-aortic balloon pump(IABP) during hospitalization.Methods A total of 350 patients undergoing IABP-assisted revascularization of high-risk coronary arteries in Qingdao Municipal Hospital from October 2014 to December 2019 were enrolled in this study.According to the incidence of MACE during hospitalization, they were divided into MACE group(n=81) and non-MACE group(n=269).The general clinical data were compared between the 2 groups.Multivariate binary logistic regression analysis was performed to analyze the risk factors for MACE.ROC curve was drawn to analyze the predictive values of the biomarkers and disease severity scores, and AUC was then calculated.Results The MACE group had older age, larger proportions of smoking, hypertension and hyperlipidemia, higher ratios of having history of cardiogenic shock and STEMI,severer coronary stenosis, and higher diastolic blood pressure, heart rate and creatinine level, but lower ratio of history of unstable angina pectoris, lower systolic blood pressure and LVEF,less CABG after IABP,and shorter length of hospital stay when compared with the non-MACE group(P<0.05,P<0.01).Multivariate binary logistic regression analysis showed that age(OR=1.099,95%CI:1.026-1.178,P=0.007),smoking history(OR=3.175,95%CI:1.250-8.067,P=0.015),hyperlipidemia(OR=3.430,95%CI:1.453-8.067,P=0.005),cardiogenic shock(OR=7.047,95%CI:3.174-15.645,P=0.001),severity of coronary stenosis(OR=1.097,95%CI:1.007-1.194,P=0.034),creatinine(OR=1.008,95%CI:1.002-1.013,P=0.004) were independent risk factors for MACE,while LVEF(OR=0.897,95%CI:0.850-0.947,P=0.001) was a protective factor for MACE in high-risk ACS patients assisted by IABP.ROC curve analysis indicated that the AUC values were as follows: age(0.669),smoking history(0.602),hyperlipidemia(0.722),severity of coronary artery stenosis(0.627),cardiogenic shock(0.846),creatinine(0.789),and LVEF(0.168).Conclusion For the patients with high-risk ACS assisted by IABP,drugs and surgery should be used as soon as possible to relieve coronary artery stenosis.Improving LVEF and avoiding cardiogenic shock are effective to reduce the risk of MACE in them.
作者
赵航
孙晓薇
王晓腾
衣英凡
于忠祥
Zhao Hang;Sun Xiaowei;Wang Xiaoteng;Yi Yingfan;Yu Zhongxiang(Qingdao Medical College,Qingdao University,Qingdao 266000,Shandong Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2022年第9期920-923,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
