心肌梗死溶栓危险指数与急性心肌梗死患者冠状动脉病变严重程度及介入治疗远期预后的关系  

Relationship between thrombolysis in myocardial infarction risk index and the severity of coronary artery lesions and long-term outcome in acute myocardial infarction patients undergoing percutaneous coronary intervention

作　　者：陈艳[1] 宋莹[1] 许晶晶[1] 唐晓芳[1] 王欢欢[1] 蒋萍[1] 姜琳[1] 刘如[1] 赵雪燕[1] 高立建[1] 宋雷[1] 张茵[1] 陈珏[1] 高展[1] 乔树宾[1] 杨跃进[1] 高润霖[1] 徐波[1] 袁晋青[1] Chen Yan;Song Ying;Xu Jingjing;Tang Xiaofang;Wang Huanhuan;Jiang Ping;Jiang Lin;Liu Ru;Zhao Xueyan;Gao Lijian;Song Lei;Zhang Yin;Chen Jue;Gao Zhan;Qiao Shubin;Yang Yuejin;Gao Runlin;Xu Bo;Yuan Jinqing(Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院、国家心血管病中心、阜外医院心内科,100037

出　　处：《中华心血管病杂志》2018年第11期874-881,共8页Chinese Journal of Cardiology

基　　金：国家重点研发计划(2016YFC1301301).

摘　　要：目的 探讨心肌梗死溶栓危险指数(TRI)与急性心肌梗死(AMI)患者冠状动脉病变严重程度及介入治疗远期预后的关系.方法 采用前瞻性研究方法,连续纳入2013年1至12月在阜外医院接受经皮冠状动脉介入治疗(PCI)的AMI患者1 663例.冠状动脉病变的严重程度通过SYNTAX评分评估.采用受试者工作特征(ROC)曲线分析TRI预测PCI术后2年全因死亡的最佳截断值.根据最佳截断值(23.05),将AMI患者分为高TRI组(TRI≥23.05,465例)和低TRI组(TRI<23.05,1 198例).采用多因素logistic回归分析TRI与SYNTAX评分≥33分的相关性.采用Cox比例风险回归模型分析PCI术后远期预后的影响因素.结果 高TRI组患者的SYNTAX评分高于低TRI组[13.00(7.00,20.50)分比10.25(7.00,17.00)分,P<0.001].多因素logistic回归分析显示,TRI与SYNTAX评分≥33分独立相关(OR=1.09,95% CI 1.03~1.16,P=0.004).术后2年,高TRI组全因死亡[4.1%(19/465)比0.3%(4/1 198), P<0.001]、心原性死亡[2.6%(12/465)比0.2%(2/1 198),P<0.001]和支架内血栓形成[1.7%(8/465)比0.5%(6/1 198),P=0.015]发生率均高于低TRI组.多因素Cox回归分析显示,TRI≥23.05是AMI患者PCI术后2年全因死亡(HR=5.22,95% CI 1.63~16.72,P=0.005)、心原性死亡(HR=8.48,95% CI 1.75~41.07,P=0.008)和支架内血栓形成(HR=3.87,95% CI 1.32~11.41,P=0.014)的独立危险因素,不是术后2年严重不良心脑血管事件的独立危险因素(HR=0.96,95%CI 0.69~1.36,P=0.834).TRI≥23.05预测AMI患者PCI术后2年全因死亡的ROC曲线下面积为0.803(95% CI 0.711~0.894,P<0.001).结论TRI与SYNTAX评分≥33分独立相关;高TRI是AMI患者PCI术后2年全因死亡、心原性死亡和支架内血栓形成的独立危险因素.Objective To investigate the relationship between thrombolysis in myocardial infarction risk index(TRI) and the severity of coronary artery lesions and long-term outcome in acute myocardial infarction(AMI) patients undergoing percutaneous coronary intervention(PCI).Methods A total of 1 663 consecutive AMI patients undergoing PCI between January and December 2013 in Fuwai hospital were prospectively included in this study. The severity of coronary artery lesions was evaluated using the SYNTAX score. Receiver operating characteristic(ROC) curve was used to analyze the optimal cut-off value of TRI on predicting all-cause mortality at 2 years after PCI.The patients were divided into 2 groups based on the optimal cut-off value of TRI:high TRI group (TRI≥23.05,465 cases) and low TRI group(TRI<23.05, 1 198 cases). Multivariate logistic regression analyses were used for determining the relationship between TRI and SYNTAX scores≥33. A multivariate Cox regression analyses was used to identify the influence factors of long-term outcome after PCI. Results SYNTAX score was higher in high TRI group than in low TRI group (13.00(7.00, 20.50) vs. 10.25(7.00, 17.00),P<0.001). TRI was independently associated with SYNTAX score≥33 (OR=1.09,95% CI 1.03-1.16,P=0.004). After the 2 years follow-up, rates of all-cause death (4.1%(19/465)vs. 0.3%(4/1 198),P<0.001), cardiac death (2.6%(12/465)vs. 0.2%(2/1 198),P<0.001) and stent thrombosis (1.7%(8/465)vs. 0.5%(6/1 198),P=0.015) were all significantly higher in high TRI group than in low TRI group. Multivariate Cox regression analyses showed that TRI≥23.05 was an independent risk factor of all-cause death (HR=5.22,95%CI 1.63-16.72,P=0.005), cardiac death (HR=8.48 , 95%CI 1.75-41.07 ,P=0.008) and stent thrombosis(HR=3.87 ,95%CI 1.32-11.41 ,P=0.014) at 2 years after PCI in AMI patients, but which was not the independent risk factor of major adverse cardiovascular and cerebrovascular events(HR=0.96,95% CI 0.69-1.36,P=0.834). The area under ROC curve of TRI≥23.05 on predicting 2 years

关 键 词：心肌梗死 经皮冠状动脉介入治疗 心肌梗死溶栓危险指数 

分 类 号：R542.22[医药卫生—心血管疾病]