ST段抬高型急性心肌梗死患者入院7天仍存在充血性心力衰竭事件分析  

Risk Factor Analysis on Congestive Heart Failure in Patients With ST-Segment Elevation Myocardial Infarction in 7 Days

作　　者：王曼[1] 朱俊[1] 杨艳敏[1] 谭慧琼[1] 刘力生[1] 刘尧[1] 张晗[1] 代表CREATE中国课题组 

机构地区：[1]中国医学科学院 北京协和医学院 心血管病研究所 阜外心血管病医院心血管疾病国家重点实验室急症抢救中心,北京市100037

出　　处：《中国循环杂志》2013年第1期9-12,共4页Chinese Circulation Journal

摘　　要：目的:探讨ST段抬高型急性心肌梗死(STEMI)患者入院7天仍存在充血性心力衰竭(心衰)的影响因素。方法:采用国际多中心CREATE研究的7 486例STEMI患者资料,分为心衰组和非心衰组。用单变量和多变量Logistic回归分析合并心衰患者的基线特征因素和治疗因素,分析心衰发生的危险因素。结果:入院7天5 989例(80.0%)无心衰(非心衰组),1 497例(20.0%)仍存在心衰(心衰组),其中1 404例(93.8%)发生在入院24 h内,493例(32.9%)30天内死亡。心衰组女性、前壁心肌梗死、既往心衰史、心肌梗死史、高血压病史、糖尿病史、卒中史比例高于非心衰组,收缩压、舒张压低于非心衰组,平均心率高于非心衰组,心衰组入院时HbA1C和基线血糖水平均高于非心衰组。心衰组患者接受经皮冠状动脉介入治疗(PCI)及服用阿司匹林、血管紧张素转换酶抑制剂(ACEI)、β受体阻滞剂和降脂药的比例均低于非心衰组。Logistic回归分析显示既往心衰史、高血压病史、基线血糖、年龄和心率是心衰的危险因素,入院后接受PCI治疗、服用β受体阻滞剂和降脂药、收缩压和舒张压是心衰的保护因素。结论:STEMI患者24 h内易发生心衰,30天死亡率高,但接受积极治疗的比例低于无合并心衰的患者。对高危患者入院后应尽早行PCI及加用β受体阻滞剂和降脂药治疗,同时注意避免低血压的发生。Objective ：To analyze the risk factor on congestive heart failure （CHF） in patients with ST-segment elevation myocardial infarction（STEMI） in 7 days. Methods ： A total of 7486 patient records from international CREATE study were recruited, and logistic regression analysis was performed to study the baseline characters and treatments for determining the risk factor for CHF occurrence. Results：For a 7-day follow-up period,there were 1497/7486 （20.0%） patients still had CHF,93.8% of them occurred within the first 24 hours of MI onset and 493 （32. 9% ） patients died within 30 days. Compared with non-CHF patients, CHF pa- tients presented more female gender, anterior MI, prior history of heart failure, myocardial infarction, hypertension, diabetes meUi- tus and stroke; they also showed lower systolic and diastolic blood pressure,faster average heart rate and higher baseline levels of HbA1C and blood glucose at admission. Compared with non-CHF patients,there were less CHF patients received PCI treatment, oral aspirin, β receptor blocker and lipid lowering medication. Logistic regression analysis indicated that the prior history of heart failure,hypertension,baseline blood glucose level,age and heart rate were the risk factors for CHF; while PCI treatment,taking 13 receptor blocker,lipid lowering medication, systolic and diastolic blood pressure were the protective factors for CHF occurrence. Conclusion：CHF frequently happened during first 24 hours in STEMI patients, the mortality was high in 30 days, while less patients received proper management. PCI, 15 receptor blocker and lipid lowering medication should be used in high risk patients as soon as possible, and meanwhile,to avoid hypotension occurrence.

关 键 词：ST段抬高型急性心肌梗死 充血性心力衰竭 LOGISTIC回归 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]