急性冠脉综合征患者经皮冠状动脉介入治疗后心力衰竭高危因素分析

目的探讨急性冠脉综合征（ACS）患者行经皮冠状动脉介入治疗（PCI）术后发生心力衰竭的高危因素。方法连续选取解放军第252医院2009年1月至2012年12月因ACS行PCI治疗的患者520例，根据患者术后是否发生心力衰竭分为心力衰竭组（n＝67）和对照组（n＝453），分别统计患者合并高血压、糖尿病病史、吸烟史、陈旧性心肌梗死史、既往心力衰竭病史，分析患者冠状动脉造影影像结果、手术操作时间、对比剂用量及住院期间血糖、血脂、血常规等血液检查指标。结果67例患者术后发生心力衰竭。与对照组比较，心力衰竭组住院时间明显延长、死亡率明显升高（P＜0.05）。此外，心力衰竭组手术操作时间明显较长、对比剂用量明显增多、合并糖尿病比例明显升高、累及前降支病变比例明显增多、不稳定型心绞痛比例明显减少、心肌梗死比例明显增加（P＜0.05）。血液检查指标分析显示，心力衰竭组低密度脂蛋白胆固醇、肌酐、尿酸、白细胞水平明显高于对照组（P＜0.05）。多因素logistic回归分析显示，年龄、前降支病变、白细胞计数、尿酸是ACS患者PCI术后发生心力衰竭的高危因素。结论前降支病变合并入院白细胞计数、尿酸水平明显升高的老年患者为PCI术后发生心力衰竭的高危患者。

Risk factors of heart failure in patients with acute coronary syndrome after percutaneous coronary intervention

Objective To investigate the risk factors of heart failure in patients with acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI）. Methods A total of 520 patients undergoing PCI due to ACS in our hospital from 2009 to 2012 were enrolled in this study. Then they were divided into heart failure group （n=67） and control group （n=453） according to the emergence of heart failure after PCI. Their clinical data were collected and retrospectively analyzed. The numbers of patients with histories of hypertension, diabetes, smoking, old myocardial infarction or prior history of heart failure were calculated. Their coronary angiography images, operation time, amount of contrast agent, and the levels of blood glucose, blood lipids, and other blood test indicators during hospitalization were analyzed between the 2 groups. Results Sixty-seven patients had heart failure after PCI. Compared to control group, they suffered a longer hospitalization and significantly higher mortality （P〈0.05）. What’s more, the heart failure group had longer operation time, larger amount of contrast agent, higher ratio of diabetes, more lesions in anterior descending artery, less incidence of unstable angina pectoris, and higher incidence of myocardial infarction than the control group （P〈0.05）. Blood test showed that the levels of low-density lipoprotein cholesterol, creatinine and uric acid, and the white cell count were significantly higher in the heart failure group than in the control group （P〈0.05）. Linear logistic regression analysis showed that age, left anterior descending artery lesion, white blood cell count, uric acid level were the high risk factors of heart failure after PCI. Conclusion Elderly patients with anterior descending artery lesions combined with higher white blood cell count and uric acid level are in higher risk of heart failure after PCI.