直接PCI治疗急性ST段抬高型心肌梗死患者的近期预后及相关因素分析  

Recent prognosis of acute STEMI patients treated by primary PCI and related factor analysis

作　　者：戴美凤[1] 沈彬[1] 陆传新[1] 赵宏坤[1] 朱永武[1] 蒋逸风[1] DAI Mei- feng SHEN Bin LU Chuan-xin ZHAO Hong-kun ZHU Yong-wu JIANG Yi-feng(Department of Cardiology, 411^st Hospital of Chinese PLA, Shanghai, 200081, China)

机构地区：[1]解放军第411医院心血管内科,上海市200081

出　　处：《心血管康复医学杂志》2017年第3期273-276,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:评价直接经皮冠状动脉介入治疗(PCI)急性ST段抬高型心肌梗死(STEMI)患者的近期预后,探讨其相关危险因素。方法:回顾性分析168例直接PCI治疗的STEMI患者的临床资料,根据30d内是否发生不良心血管事件(MACE)分为预后不佳组(40例)和预后良好组(128例),比较两组的临床资料,采用Logistic回归分析MACE发生的独立危险因素。结果:168例直接PCI治疗的STEMI患者MACE发生率为23.81%。Logistic回归分析显示MACE发生的独立危险因素有年龄(OR=1.326,95%CI 1.168~1.505)、冠心病家族史(OR=1.852,95%CI 1.369~2.505)、病变支数(≥2)(OR=1.682,95%CI 1.382~2.047)、Killip′s分级Ⅲ~Ⅳ级(OR=1.693,95%CI 1.428~2.007)和发病至PCI时间(OR=1.785,95%CI 1.425~2.236),P均<0.01;保护因素有TIMI 3级(OR=0.623,95%CI 0.518~0.749)、应用替罗非班(OR=0.452,95%CI 0.367~0.557),P均<0.01。结论:高龄、冠心病家族史、病变支数≥2、心功能差和发病至PCI时间长是急性ST段抬高型心肌梗死患者MACE发生的独立危险因素,而TIMI 3级和应用替罗非班是其保护因素。Objective： To evaluate recent prognosis of patients with acute ST elevation myocardial infarction （STEMI） treated by primary percutaneous coronary intervention （PCI）, and explore related risk factors. Methods： Clinical data of 168 STEMI patients undergoing primary PCI were retrospectively analyzed. According to occurrence of ma- jor adverse cardiovascular events （MACE） within 30d or not, they were divided into poor prognosis group （n = 40） and good prognosis group （n = 128）. Clinical data were compared between two groups. Logistic regression analysis was used to analyze independent risk factors for MACE. Results： Incidence rate of MACE was 23.81% among the 168 STEMI patients. Logistic regression analysis indicated that age （OR = 1.326, 95% CI 1.168 - 1.505）, family history of coronary heart disease （OR = 1.852, 95% CI 1.369-2. 505）, number of diseased vessels ≥2 （OR = 1.682, 95%CI 1.382-2. 047）, Killip＇s class Ⅲ - Ⅳ （OR = 1.693, 95%CI 1.428-2. 007） and onset-to-PCI time （OR= 1.785, 95%CI 1.425-2. 236） were the independent risk factors, P〈0.01 all; TIMI grade 3 （OR= 0. 623, 95% CI 0. 518-0. 749） and tirofiban application （OR = 0. 452, 95% CI 0. 367- 0. 557） were independent protective factors for MACE, P〈0. 01 both. Conclusion： Advanced aged, family history of coronary heart disease, number of diseased vessels ≥2, poor cardiac function and long onset-to-PCI time are independent risk factors, while TIMI grade 3 and tirofiban application are independent protective factors for MACE.

关 键 词：血管成形术 气囊 冠状动脉 心肌梗死 预后 

分 类 号：R542.22[医药卫生—心血管疾病]