急性ST段抬高型心肌梗死患者介入治疗术后死亡率的长期随访观察及预测因素分析  

Long-term follow-up and analysis of prediction of mortality after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

作　　者：鲍丹[1] 韩雅玲[1] 荆全民[1] 王效增[1] 马颖艳[1] 王耿[1] 赵昕[1] 刘海伟[1] 李晶[1] 王誉诺 李毅[1] 

机构地区：[1]沈阳军区总医院心内科,沈阳110016

出　　处：《解放军医学杂志》2015年第4期275-278,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家"十二五"科技支撑计划课题(2011BAI11B07)~~

摘　　要：目的探讨急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后随访期间发生死亡的危险因素。方法入选我院2008年7月-2012年11月确诊为STEMI,并于住院期间接受PCI治疗的连续病例,观察患者随访期间存活率。采用病例对照研究方法,分析影响存活率的独立预测因素。结果共入选3551例患者,最长随访5年,中位随访时间406[179~892]d,随访期间共106例患者死亡。Kaplan-Meier曲线法估测此类患者5年生存率为88.6%。多变量分析结果显示,女性、年龄、糖尿病、卒中、血压异常、肾功能不全、肌酸激酶同工酶MB（CKMB）增高、左室舒张末内径、贫血、前壁心梗、主动脉内气囊反搏（IABP）、PCI并发症等是随访期间死亡的独立危险因素,而完全血运重建可降低死亡风险。结论 STEMI患者即便PCI治疗成功,远期死亡发生率仍较高。减少PCI并发症、早期完全血运重建是降低随访死亡发生率的独立预测因素。Objective To explore the risk factors for mortality after percutaneous coronary intervention （PCI） in patients with acute ST segment elevation myocardial infarction （STEMI）. Methods The patients who were admitted with STEMI to our hospital between July 2008 and November 2012 undergoing PCI during hospitalization were enrolled. Case control study was conducted to observe these patients during the follow-up period for exploring the independent predictors of survival. Results A total of 3551 consecutive patients were enrolled in this study. These patients were followed up for 5 years with a median follow- up time of 4061179, 892] days. A total of 106 deaths occurred during the follow-up period. Estimated 5-year survival rate was 88.6% by Kaplan-Meier method. Female, age, diabetes, stroke, dysarteriotony, renal insufficiency, elevation of creatinine kinase isoenzyme MB （CK-MB）, left ventricular end diastolic dimension, anemia, anterior myocardial infarction, PCI complications and intra-aortic balloon pump （IABP） were independent risk factors for mortality, whereas complete revascularization was associated with decreased risk of mortality. Conclusions Long-term mortality rate of patients with STEMI is higher even after successful PCI. Less PCI complications and early complete revascularization are independent predictors for decreasing mortality rate during follow-up period.

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 死亡率 

分 类 号：R542.22[医药卫生—心血管疾病]