急性ST段抬高型心肌梗死患者急诊PCI术后短期不良心血管事件发生情况及其影响因素  

Short-term adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction after emergency PCI and their risk factors

作　　者：杨英[1] 杨简[1] 刘晓雯 王辉波[1] 杨俊[1] YANG Ying;YANG Jian;LIU Xiaowen;WANG Huibo;YANG Jun(Yichang Central People′s Hospital,Yichang 443000,China)

机构地区：[1]宜昌市中心人民医院,湖北宜昌443000

出　　处：《山东医药》2018年第40期10-14,共5页Shandong Medical Journal

摘　　要：目的观察急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后短期不良心血管事件发生情况,并分析其影响因素。结论回顾性分析122例接受急诊PCI术的STEMI患者临床资料,平均随访13. 07个月,观察随访期间不良心血管事件发生情况。比较STEMI患者急诊PCI术后不良心血管事件发生与未发生者的一般资料、血液生化指标、介入治疗情况。采用Logistic回归分析STEMI患者急诊PCI术后不良心血管事件发生的影响因素。结果 STEMI患者急诊PCI术后发生不良心血管事件40例、未发生82例。STEMI患者急诊PCI术后不良心血管事件发生者吸烟史阳性率、心功能≥Ⅱ级比例、症状至PCI时间高于未发生者(P均<0. 05)。STEMI患者急诊PCI术后不良心血管事件发生者中性粒细胞/淋巴细胞、直接胆红素水平高于未发生者,总胆固醇水平低于未发生者(P均<0. 05)。STEMI患者急诊PCI术后发生不良心血管事件者较未发生者最大支架长度长、植入临时起搏器例数多(P均<0. 05)。Logistic回归分析显示,吸烟史(OR=2. 63,95%CI:1. 02～6. 76,P=0. 04)、心功能≥Ⅱ级(OR=3. 18,95%CI:1. 20～8. 43,P=0. 02)、直接胆红素水平(OR=1. 23,95%CI:1. 02～6. 76,P=0. 01)为STEMI患者急诊PCI术后发生不良心血管事件的影响因素。结论 STEMI患者急诊PCI术后会发生短期不良心血管事件。有吸烟史、心功能≥Ⅱ级、血浆直接胆红素水平高是STEMI患者急诊PCI术后短期不良心血管事件发生的危险因素。Objective To investigate the incidence of short-term adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods Totally 122 STEMI patients undergoing emergency PCI were retrospectively analyzed.The mean follow-up period was 13.07 months.The occurrence of adverse cardiovascular events during the follow-up period was observed.The general clinical data,blood biochemical indices and interventional treatment were compared between the adverse cardiovascular events group and no-events group.Logistic regression analysis was used to analyze the risk factors of adverse cardiovascular events in patients with STEMI after emergency PCI.Results Forty cases had adverse cardiovascular events and 82 cases did not.The positive rate of smoking history,the proportion of cardiac function(>grade II)and the time from symptom to PCI in STEMI patients with adverse cardiovascular events were higher than those without(all P<0.05).Neutrophil/lymphocyte and direct bilirubin levels were higher in STEMI patients with adverse cardiovascular events than in those without,and total cholesterol levels were lower than those of patients without(all P<0.05).The patients with adverse cardiovascular events had longer maximum stent length and more temporary pacemaker implantation than those without(all P<0.05).Logistic regression analysis showed that smoking history(OR=2.63,95%CI:1.02-6.76,P=0.04),cardiac function(>II)(OR=3.18,95%CI:1.20-8.43,P=0.02),direct bilirubin(OR=1.23,95%CI:1.02-6.76,P=0.01)were the risk factors for adverse cardiovascular events in STEMI patients after emergency PCI.Conclusions Short-term adverse cardiovascular events occur in patients with STEMI after emergent PCI.Smoking history,cardiac function(>grade II)and high level of plasma direct bilirubin are risk factors for short-term adverse cardiovascular events in STEMI patients after emergency PCI.

关 键 词：不良心血管事件 急性ST段抬高型心肌梗死 急诊经皮冠状动脉介入治疗 直接胆红素 

分 类 号：R543.3[医药卫生—心血管疾病]