急诊经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者的#br#住院期间预后分析

目的：分析急诊经皮冠状动脉介入(percutaneous coronary intervention，PCI)治疗急性心肌梗死(acute myocardial infarction，AMI)患者的病例资料，旨在探讨影响急诊PCI治疗AMI患者住院期间不良预后的相关因素。方法：回顾性分析2010年1月至2014年12月中南大学湘雅二医院行急诊PCI治疗AMI的患者资料，根据是否发生心血管不良事件分为事件组及非事件组，比较两组间可能引起心血管不良事件发生的相关因素。结果：不良事件的发生率为22%(67/304)；通过t检验或χ2检验发现：肌酐，脑钠肽(brain natriuretic peptide，BNP)，红细胞比容，白细胞、年龄>75岁，Killip分级≥2级，术后心肌梗死溶栓治疗(thrombolysis in myocardial infarction，TIMI)血流≤2级，术前发生心律失常、多支病变，术后2 h ST段回落率<50%，长就诊至球囊扩张(door-to-balloon，D2B)时间差异具有统计学意义(P<0.05)，进一步进行logistic回归分析，其结果显示：红细胞比容(red blood cell specific volume，HCT)、N 端脑钠肽激素原前体(N-terminal pro-brain natriuretic peptide，NT-proBNP)、Killip分级≥2级、术后TIMI血流≤2级、术后2 h ST段回落率<50%、长D2B时间是心血管不良事件发生的重要影响因素。结论：HCT，NT-proBNP，Killip分级≥2级，术后TIMI血流≤2级，术后2 h ST段回落率<50%、长D2B时间是心血管不良事件发生的重要影响因素，对上述高危患者进行积极的监测与处理，能够有效改善AMI患者急诊PCI术后的预后，减少住院期间不良事件的发生。

Influencial factors for in-hospital patients with ST segment elevation myocardial infarction after emergency percutaneous coronary intervention

Objective: To analyze the clinical outcomes of emergency percutaneous intervention in acute myocardial infarction (AMI) during hospital, and to find the relevant risk factors for the prognosis and cardiac events. Methods: We retrospective analyzed the patient with acute ST segment elevation myocardial infarction, who was successfully performed emergency percutaneous coronary intervention (PCI) in the Cardiac Cath Lab of the Second Xiangya Hospital from January 2010 to December 2014. According to situation for cardiovascular events, patients were divided into 2 groups. The clinical factors were compared between the 2 groups.Results: The incidence of adverse event was 22% (67/304). By using t test and χ2 analysis, we found that Cr, NT-proBNP, HCT, WBC, age>75, Killip grade≥2, TIMI flow after PCI≤2, arrhythmia, multi-vessel lesion, ST-segment resolution≥50%, long D2B time are statistically different between the 2 groups. Logistic analysis revealed that HCT, NT-proBNP, Killip grade≥2, TIMI flow after PCI≤2, ST-segment resolution≥50%, long D2B time were important predictors for cardiac events in-hospital.Conclusion: HCT, NT-proBNP, Killip grade≥2, TIMI flow after PCI≤2, ST-segment resolution≥50%, long D2B time are important predictors for cardiac events in-hospital. The prognosis for AMI patient after emergency PCI could be improved and the incidence of cardiac event in hospital could be reduced if the high risk factors can be properly handled.