左心室舒张末期压力对行介入治疗的急性ST段抬高型心肌梗死患者的预后价值  

The Prognostic Effect of Left Ventricular End-diastolic Pressure During Primary Percutaneous Coronary Intervention in Patients With Acute ST-segment Elevation Myocardial Infarction

作　　者：贾静静[1] 董平栓[1] 杜来景[1] 李志娟[1] 范喜梅[1] 王红雷[1] 杨喜山[1] 杨旭明[1] 

机构地区：[1]河南科技大学第一附属医院心内科,河南省洛阳市471003

出　　处：《中国循环杂志》2015年第6期543-546,共4页Chinese Circulation Journal

摘　　要：目的:评估左心室舒张末期压力(LVEDP)对新发ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉(冠脉)介入治疗(PCI)后死亡率的影响。方法:该研究为回顾性分析。入选255例行急诊PCI的新发STEMI患者,术中均在冠脉血管开通前测量LVEDP,根据LVEDP的均值[14 mm Hg(1 mm Hg=0.133 k Pa)]分为LVEDP≤14 mm Hg组和LVEDP>14 mm Hg组,观察术后6个月死亡率。运用Cox回归分析LVEDP对死亡率的影响。结果:相对LVEDP≤14 mm Hg组,LVEDP>14 mm Hg组患者术后6个月死亡的风险比(HR)为4.26(P=0.03)。相关分析显示,LVEDP与左心室射血分数(r=-0.267,P=0.001)和B型利钠肽(r=0.154,P=0.041)呈轻度相关。多因素分析显示,在调整左心室射血分数及B型利钠肽后,LVEDP是术后6个月死亡的独立预测因素(每增加5 mm Hg,HR=1.22,P=0.04)。结论:急诊PCI术中测量的LVEDP是新发STEMI患者术后死亡的独立预测因素。Objective： To evaluate the post-operative mortality of left ventricular end-diastolic pressure （LVEDP） during primary percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods： We retrospectively analyzed 255 patients with new onset of STEMI who received primary PCI in our hospital and all patients received LVEDP measurement before coronary artery opening. According to LVEDP value, the patients were divided into 2 groups： LVEDP≤14 mmHg group,n=155 and LVEDP〉14 mmHg group,n=100. The post-operative mortality up to 6 months was observed, and the effect of LVEDP on death rate was studied by Cox regression analysis. Results： Compared with LVEDP≤14 mmHg group, the patients in LVEDP〉14 mmHg group had the 6 months mortality at HR=4.26, 95% CI （1.13-16.08）,P=0.03. Relevant study presented that LVEDP was slightly related to LVEF （r=-0.267, P=0.001） and BNP （r=-0.154,P=0.041）. Multi-regression analysis indicated that with adjusted LVEF and BNP, LVEDP was the independent predictor for post-operative mortality up to 6 months in acute STEMI patients after PCI. Conclusion： The LVEDP value measured during PCI procedure is the independent predictor for mortality after PCI in patients with new onset of STEMI.

关 键 词：左心室舒张末期压力 ST段抬高型心肌梗死 死亡率 

分 类 号：R54[医药卫生—心血管疾病]