左室射血分数对急诊冠状动脉介入治疗急性ST段抬高心肌梗死患者远期预后的影响  

Effect of left ventricular ejection fraction on clinical long-term follow-up outcomes in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：王崇慧[1] 谢雪娇[2] 方全[1] 张抒扬[1] 范中杰[1] 金晓峰[1] 谢洪智[1] 刘震宇[1] 沈珠军[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院心内科,100730 [2]湖南中医药大学教育教研室

出　　处：《中华医学杂志》2011年第4期265-268,共4页National Medical Journal of China

摘　　要：目的评价左室射血分数（LVEF）对接受急诊冠状动脉介入治疗（PCI）急性sT段抬高心肌梗死患者临床预后的影响。方法158例接受了急诊PCI急性sT段抬高心肌梗死患者纳入本研究，根据出院前的LVEF分为3组：≤40％（n=14）、41％～55％（n=46）和〉55％（n：98），临床随访平均（43．1±15．2）个月，主要不良心脏事件（MACE）发生15例。结果3组在心肌梗死部位、梗夕E相关血管、单支血管病变、双支血管病变、CTnl、CK、CK—MB、高血压、糖尿病、高血脂、吸烟、肥胖、阿司匹林和氯吡格雷使用比例、氯吡格雷使用时间的差异均无统计学意义（均P〉0．05）。在LVEF≤40％和41％一55％组，平均年龄显著高于LVEF〉55％组（P〈0．0001）；在LVEF≤40％组，其三支病变的比例显著高于LVEF41％～55％和〉55％组（P=0．0036）；在INEF41％～55％组和〉55％组，其术后TIMl3级血流和完全血运重建的比例显著高于LVEF≤40％组（P=0．0099，P=0．0010），而Killip分级（Ⅱ，Ⅲ，Ⅳ级）的比例、平均的症状发作至球囊打开时问（SOTB）显著低于LVEF≤40％组（P=0．0100，P=0．0087）。在LVEF≤40％和41％～55％组，其药物支架的比例显著低于LVEF〉55％组（P=0．0242）。多因素Logistic回归分析显示，出院前LVEF是随访期总MACE发生的独立预测因素（P=0．0029），差异有统计学意义。随着LVEF的减低，在LVEF〉55％、41％～55％、≤40％组的随访期间总MACE发生率显著增加（6．12％比8．70％比35．71％，P=0．0019），随访期问总死亡和心性死亡的发生率也显著增加（1．02％比4．35％比21．43％，P=0．0090；1．02％比2．17％比14．29％，P=0．0060），差异有统计学意义。结论在接受急诊PCI的急性sT段抬高心肌梗夕匕患者，左室射血分数是其随访期MACE发生的独立预测因子，随着LVEF的减低，其随访期MACE发生率增加。Objective To evaluate the effect of left ventricular ejection fraction （LVEF） on clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods A total of 158 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. They were divided into three groups ： LVEF ≤40% （ n = 14）, LVEF 41% - 55% （ n = 46 ） and LVEF 〉 55% group （ n = 98 ） . The clinical follow-up end-point was major adverse cardiac event （MACE） including death, acute myocardial infarction, stent thrombosis and stent restenosis. The clinical follow-up duration was 43. 1±15.2 months. MACE occurred in 15 patients. Results The rates of infarction site, infarction relative artery, 1-vessel disease, 2-vessel disease, hypertension, diabetes, hyperlipidemia, smoking, obesity and aspirin use were not different in three groups （ P 〉 0. 05 ） . Average CTnI, CK,CK-MB and duration of clopidogrel use were not different in three groups （ P 〉 0. 05 ）. The rate of 3-vessel disease was significantly higher in the LVEF≤40% group than that in the LVEF 41% -55% and LVEF 〉 55% groups （P =0. 0036）. The rates of TIMI flow grades （Grade m ） and complete revascularization were significantly higher in the LVEF 41% -55% and LVEF 〉 55% groups than that in the LVEF≤40% group （ P = 0. 0099,P = O. 0010）. The rates of Killip classification （ classesⅡ , Ⅲ, Ⅳ ） and average symptom- onset-to balloon-time （SOTB） were significantly lower in the LVEF 41% - 55% and LVEF 〉 55% groups than that in the LVEF ≤ 40% group （ P = 0. 0100, P = 0. 0087 ）. The rate of drug-eluting stents was significantly lower in the LVEF≤40% group and LVEF 41% -55% group than that in LVEF 〉 55% group （P = 0. 0242）. Logistic regression analysis showed that LVEF was independent predictor for MACE in the follow-up period （P = O. 0029 ）.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 左室射血分数 预后 

分 类 号：R542.22[医药卫生—心血管疾病]