血清肌酐水平对ST段抬高性心肌梗死急诊PCI治疗患者预后的影响

目的探讨血清肌酐水平对ST段抬高性心肌梗死（STEMI）急诊经皮冠状动脉介入治疗（PCI）患者预后的影响。方法接受急诊PCI治疗的495例STEMI患者,根据入院即刻肌酐水平分为肌酐正常组409例和肌酐升高组86例,随诊1 a,比较两组患者院内和1 a时的病死率及主要不良心脏事件（MACE,包括死亡、心肌梗死、需要血运重建的心绞痛）的发生情况。结果入院肌酐升高组患者与正常组比较,年龄大,高血压患者发病率及既往心肌梗死发病率高,心功能差,院内病死率和随访1 a时病死率、MACE发生率均较高,差异有统计学意义（P均〈0.05）。多变量回归分析显示,入院肌酐水平与STEMI接受急诊PCI治疗患者1 a病死率密切相关（RR=1.41,95%CI：1.24-2.69,P=0.02）。结论STEMI接受急诊PCI治疗患者入院时的肌酐水平对预测患者预后有重要意义。

Effects of serum creatinine on prognosis in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Objective To evaluate the effects of serum creatinine on prognosis of ST-segment elevation myocardial infarction（STEMI） patients undergoing primary percutaneous cornoary intervention（PCI）.Metheds A total of 495 STEMI patients undergoing primary PCI were studied.Patients were divided into 2 groups according to admission serum creatinine level,namely elevated serum creatinine group（86 caseds） and normal serum creatinine group（409 cases）.Mortality and major adverse cardiac events（MACE,death,myocardial infarction,recun＇ent agina needing revascularization） were followed up in hospital and 1 year after primary PCI in the two groups. Results Compared with normal serum creatinine group, there was higher age, the higher morbility rate of hypertension and previous myocardial infarction, the worse heart function, higher case fatality in hospital and follow-up duration for one year and the incidence rate of MACE in elevated serum creatinine group. Multiva6able regression found that admission serum creatinine had intimate relation with 1-year mortality of STEMI patients undergoing primary PCI （ RR = 1.41,95% CI ： 1.24 - 2.69, P = 0.02）. Conclusion In STEMI patients undergoing primary PCI, the level of serum creatinine is an independent predictor for prognosis.