急性心肌梗塞急诊经皮冠脉介入治疗后长期预后的相关因素

目的:探讨急性心肌梗塞(AMI)急诊经皮冠状动脉介入(PCI)后长期预后的预测因素。方法:回顾性收集2000年1月至2005年6月共964例AMI行急诊PCI治疗的资料,分析长期随访期间临床不良事件(MACE)发生的相关因素。结果:所有病例平均随访(52.7±11.7)月,最长达8年。随访期间出现MACE者的年龄(66.16±11.34)岁:(60.04±11.49)岁]、陈旧心肌梗塞比率(67.04%∶45.24%)、心功能分级≥KillipⅡ级(71.47%∶20.60%)、反映心肌梗塞面积的CK-MB峰值(140.74±127.43)U/L∶(112.52±119.37)U/L]、糖尿病患病(63.53%∶47.22%)、入院血糖水平(11.81±7.46)mmol/L∶(9.69±4.85)mmol/L]、纤维蛋白原浓度(280.24±76.59)mg/dL∶(272.35±70.18)mg/dL]、入院白细胞水平(11.68±4.36)×109/L:(10.77±3.40)×109/L]、胸痛至球囊扩张时间(6.24±7.33)h∶(5.30±3.92)h]、冠状动脉病变Gensini记分(115.09±52.74)分:(86.26±43.91)分]明显高于未发生者(P0.05~0.01),出现MACE者心肌梗塞溶栓心肌灌注(TMP)明显差于未发生者(P=0.000)。随访期间发生MACE的独立预测因素依次为术后TMP分级≤Ⅱ级(RR=5.08,P=0.000)、陈旧心肌梗塞病史(RR=2.73,P=0.046)、入院心功能分级≥KillipⅡ级(RR=2.68,P=0.0006)、糖尿病病史(RR=2.25,P=0.025)以及心电图ST段回落不良(RR=2.12,P=0.033)。结论:术后TMP分级≤Ⅱ级、陈旧心肌梗塞病史、入院心功能分级≥KillipⅡ级、糖尿病病史以及心电图ST段回落不良均为急性心肌梗塞行急诊经皮冠状动脉患者主要心脏不良事件的独立预测因素,其中术后TMP分级≤Ⅱ级的相对危险度最大。

Analysis of predictive factors associated with major adverse cardiac event in patients undergoing PCI for acute myocardial infarction

Objective：To determine predictors of long-term major adverse cardiac event（MACE） in patients who have underwent percutaneous coronary intervention（PCI） for acute myocardial infarction（AMI）.Methods：The data analysis were performed in 964 patients undergoing primary PCI for ST elevated myocardial infarction（STEMI） from Jan 2000 to Jun 2005.The factors associated with the short-and long-term MACE of patients were analyzed.Results：All patients were followed up for 0.5 to eight years mean（52.7±11.7） months].Patients with MACE during the follow-up had greater age （66.16±11.34） years vs.（60.04±11.49） years],higher ratio of old myocardial infarction（67.04% vs.45.24%） and more ≥ Killip Ⅱ（71.47% vs.20.60%）,higher CK-MB peak （140.74±127.43） U/L vs.（112.52±119.37） U/L] and more diabetes（63.53% vs.47.22%）,higher admission blood glucose level （11.81±7.46） mmol/L vs.（9.69±4.85） mmol/L],more fibrinogen concentration （280.24±76.59） mg/dl vs.（272.35±70.18） mg/dl],higher white blood cells level （11.68±4.36） 109/L vs.（10.77±3.40） 109/L],longer time chest pain to balloon （6.24±7.33）h vs.（5.30±3.92）h],higher coronary artery disease Gensini points （115.09±52.74） scores vs.（86.26±43.91） scores] than those of patients without MACE（P〈0.05-0.01）.Thrombolysis in myocardial infarction myocardial perfusion（TMP） of patients with MACE was significantly worse than that of those without MACE（P=0.000）.The independent predictors of MACE during follow-up were successively postoperative TMP ≤Ⅱgrade（RR=5.08,P=0.000）,old history of myocardial infarction（RR=2.73,P=0.046）,cardiac function admission ≥ Killip Ⅱ class（RR=2.68,P=0.0006）,a history of diabetes（RR=2.25,P=0.025）,and ST segment bad fall（RR=2.12,P=0.033）.Conclusion：During follow-up,independent predictors of major adverse cardiac event in patients undergoing percutaneous coronary intervention for acute myocardial infarction were postoperative TMP ≤ Ⅱgrade,old history of myocardial infarction,cardiac function admission ≥ Killip Ⅱ class,a history of diabetes,and ST segment bad fall,among which relative risk of postoperative TMP ≤ Ⅱ grade has greatest value.