老年急性冠脉综合征患者经皮冠状动脉介入术后新发心肌梗死影响因素分析

目的探讨老年急性冠脉综合征（ACS）患者经皮冠状动脉介入术（PCI）后新发心肌梗死的影响因素。 方法选取2019年2月至2020年2月中国人民解放军空军特色医学中心收治的PCI后发生心肌梗死的老年ACS患者61例纳入新发心梗组，另择同期收治的PCI后未发生心肌梗死的老年ACS患者61例纳入无新发心梗组。先行单因素分析（包括χ²检验、t检验、秩和检验）比较两组患者的临床资料，再将有意义的指标纳入多因素logistic回归模型进一步分析。 结果新发心肌梗死患者合并高血压控制不良比例及纤维蛋白原、基质金属蛋白酶-9（MMP-9）水平均高于无新发心肌梗死患者，白蛋白水平低于无新发心肌梗死患者，差异均具有统计学意义（χ²=14.226，Z=7.699，t=3.142、5.464，P<0.01）。多因素logistic回归分析结果显示，合并高血压控制不良、纤维蛋白原水平高、MMP-9高表达是老年ACS患者PCI后新发心肌梗死的危险因素（OR=7.559、5.169、1.024，95%CI=1.034-55.271、2.624-10.183、1.003-1.046，P<0.05或0.01），白蛋白水平高是其保护因素（OR=0.752，95%CI=0.652-0.867，P<0.01）。 结论高血压者血压控制不良、纤维蛋白原高水平、MMP-9高表达及白蛋白低水平可能是老年ACS患者PCI后新发心肌梗死的危险因素。

Influencing factors for new myocardial infarction after percutaneous coronary intervention in elderly patients with acute coronary syndrome

ObjectiveTo analyze the influencing factors of new myocardial infarction after percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS). MethodsThe medical records from February 2019 to February 2020 were collected from the Air Force Medical Center, People's Liberation Army of China. Sixty-one patients were included in the new myocardial infarction group and 61 patients were included in the no new myocardial infarction group. The influencing factors of new myocardial infarction after PCI in elderly patients with ACS were explored through univariate (including χ² test, t test and rank-sum test) and multivariate logistic regression analysis. ResultsThe rate of poor blood pressure control, levels of fibrinogen, matrix metalloproteinase-9 (MMP-9) were higher, and the level of albumin was lower in patients with new myocardial infarction (χ²=14.226; Z=7.699; t=3.142, 5.464; P < 0.01). Multivariate logistic regression analysis showed that poor blood pressure control, high level of fibrinogen and high expression of MMP-9 were the risk factors of new myocardial infarction after PCI in elderly ACS patients (OR=7.559, 5.169, 1.024; 95%CI=1.034-55.271, 2.624-10.183, 1.003-1.046; P < 0.05 or P < 0.01), and high level of albumin was the protective factor (OR=0.752, 95%CI=0.652-0.867, P < 0.01). ConclusionPoor blood pressure control of hypertension, high fibrinogen level, high expression of MMP-9 and low albumin level may be the risk factors of new myocardial infarction after PCI in elderly ACS patients.