急诊PCI术后早期左室收缩功能保留患者心力衰竭的预测因素分析  

Analysis on the predictive factors of heart failure after recanalization of IRA for AMI patients with preserved systolic function of left ventricle

作　　者：徐家梁 刘明[1] 何志松[1] 程绪杰[1] 蒋廷波[1] 

机构地区：[1]苏州大学附属第一医院心内科,江苏苏州215031

出　　处：《中国急救医学》2016年第5期401-405,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金青年项目（81400200）

摘　　要：目的对急性心肌梗死（AMI）患者行经皮冠状动脉介入术（PCI）后早期左室收缩功能保留的心力衰竭发生情况及其预测因素进行分析，以期探讨其发生的相关因素。方法回顾2013—01～2015—04接受急诊PCI术治疗的早期左室收缩功能保留的AMI患者413例，根据冠状动脉再通后是否出现心力衰竭分为心力衰竭组和非心力衰竭组，经多因素Logistic回归分析，筛选出与其相关的危险因素，并绘制ROC曲线来判断预测效果。结果①AMI患者PCI术后早期左室收缩功能保留的心力衰竭与左房内径（LA）、女性比例、主干前降支梗死、近段梗死、多支病变、中性粒细胞、高敏C-反应蛋白（hs-CRP）、左室收缩末内径（LVS）、发病至血管再通时间及高血压病史呈正相关，各组比较差异有统计学意义（P〈0．05）。②多因素Logistic回归分析显示，女性、主干前降支梗死、近段梗死、多支病变、中性粒细胞、hs—CRP、发病至血管再通时间及高血压病史是早期射血分数（EF）保留患者发生心力衰竭的独立预测因素。ROC曲线下面积为0．783（95％CI0．739～0．828，P〈0．001）。结论女性、主干前降支梗死、近段梗死、多支病变、中性粒细胞高、hs—CRP高、发病至血管再通时间长及既往高血压病史增加AMI患者急诊PCI术后早期左室收缩功能保留的心力衰竭发生的危险性。Objective To investigate the risk and predictive factors for the occurrence of heart failure after recanalization of infarct-related artery （IRA） during percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI） patients with preserved systolic function of left ventricle. Methods 413 AMI patients with preserved ejection fraction who were treated by the PCI from January 2013 to April 2015 in hospital were divided into heart failure group and control group, and their clinical data were statistically analyzed. Risk factors related to heart failure were analyzed by multifactorial logistic regression analysis and the predicted effect was determined by ROC curve. Results ①The heart failure of AMI patients with preserved systolic function of left ventricle was positively associated with left atrial diameter, women, the infarct artery of left main coronary artery or left anterior descending branch, proximal vessel infarction, multi-vessel lesion, neutrophil, hs-CRP, LVS, vascular opening time and history of hypertension, where the difference between groups was statistically significant （P 〈 0.05）. ② Multifactorial logistic regression analysis showed that women, the infarct artery of left main coronary artery or left anterior descending branch, proximal vessel infarction, multi-vessel lesion, neutrophil, hs-CRP, vas- cular opening time and history of hypertension were independent predictors of heart failure. ROC curve analysis for this prediction model showed that the area under the curve was 0.783 （95%CI 0.739 ～ 0.828, P 〈 0.001）. Conclusion Women, the infarct artery of left main coronary artery or left anterior descending branch, proximal vessel infarction, multi-vessel lesion, high neutrophil, high hsCRP, long vascular opening time and history of hypertension can increase the possibility for patients with preserved systolic function of left ventricle of heart failure after PCI, and can reduce the incidence of it after PCI.

关 键 词：射血分数(EF) 急性心肌梗死(AMI) 经皮冠状动脉介入术(PCI) 心力衰竭 

分 类 号：R544.1[医药卫生—心血管疾病]