ST段抬高型心肌梗死患者预防性放置主动脉内球囊反搏的临床疗效分析  

Evaluation of clinical efficacy of prophylactic intra-aortic balloon pump insertion in patients with ST-segment elevation myocardial infarction

作　　者：孔真真 张静梅[1,2] 乔帅华 魏钟海 徐标[1] KONG Zhenzhen;ZHANG Jingmei;QIAO Shuaihua;WEI Zhonghai;XU Biao(Department of Cardiology,Affiliated Drum Tower Hospital,School of Medicine,Nanjing University,Nanjing,Jiangsu 210008,China;Department of Cardiology,Yizheng Hospital,Nanjing Drum Tower Hospital Group,Yizheng,Jiangsu 211900,China)

机构地区：[1]南京大学医学院附属鼓楼医院心内科,江苏省南京市210008 [2]南京鼓楼医院集团仪征医院心内科,江苏省仪征市211900

出　　处：《中国动脉硬化杂志》2020年第5期435-441,共7页Chinese Journal of Arteriosclerosis

基　　金：南京市医学科技发展课题资助(YKK17085)。

摘　　要：目的分析ST段抬高型心肌梗死患者急诊冠状动脉介入治疗前预防性放置主动脉内球囊反搏(IABP)的远期临床疗效。方法收集接受急诊冠状动脉介入治疗且未合并心源性休克的646例ST段抬高型心肌梗死患者的临床资料,预防性放置IABP组(pIABP组)为冠状动脉介入治疗前预防性放置主动脉内球囊反搏的患者25例,对照组为采用倾向得分匹配法筛选出的术前未预防性放置IABP的患者75例。分析两组患者的临床特点并比较其远期临床预后。结果倾向匹配后两组患者的Killips分级和糖尿病史仍存在显著统计学差异(P=0.001和P=0.018),其余各项基线资料基本平衡。随访中位数时间21个月(四分位间距1~28个月)。全因死亡患者pIABP组7例(28%),对照组18例(24%),pIABP组心源性死亡6例(24%),对照组9例(12%),对照组主要不良心脑血管事件发生率为45.3%,pIABP组主要不良心脑血管事件累计发生率为56%。Kaplan-Meier生存分析中,两组患者的全因死亡率和心源性死亡率差异无显著性(P=0.519和P=0.103),两组患者的主要不良心脑血管事件累计发生率差异无显著性(P=0.275)。多因素Cox回归分析显示,校正两组患者的Killips分级和糖尿病史后,预防性放置主动脉内球囊反搏对于远期临床预后仍然没有显著影响(P=0.917)。结论急诊介入治疗前预防性放置主动脉内球囊反搏未能显著改善血流动力学稳定的ST段抬高型心肌梗死患者的远期临床预后。Aim To investigate the long-term clinical efficacy of prophylactic intra-aortic balloon pump(pIABP)insertion before primary percutaneous coronary intervention in the patients with ST-segment elevation myocardial infarction.Methods 646 patients with ST-segment elevation myocardial infarction but without cardiogenic shock,who have received primary percutaneous coronary intervention were enrolled.pIABP group consists of the 25 patients who have received prophylactic intra-aortic balloon pump insertion before percutaneous coronary intervention,while the control group consists of 75 patients selected from the patients without prophylactic intra-aortic balloon pump insertion before percutaneous coronary intervention by propensity score matching method.The clinical features were analyzed and the clinical prognosis of the two groups was compared.Results After propensity score matching,there were no significant differences in the baseline data except the Killips classification and diabetes history(P=0.001 and P=0.018).The median follow-up time was 21 months(interquartile range 1~28 months).There were 7 cases(28%)of all-cause death in the pIABP group and 18 cases(24%)in the control group.There were 6 cases(24%)of cardiogenic death in the pIABP group and 9 cases(12%)in the control group.The incidence of major adverse cardiovascular and cerebrovascular events was 45.3%in the control group and 56%in the pIABP group.By Kaplan-Meier analysis,there were no significant differences in all-cause mortality and cardiogenic mortality between the two groups(P=0.519 and P=0.103 respectively).There was also no significant difference in the cumulative incidence of major adverse cardiovascular and cerebrovascular events between the two groups(P=0.275).The multivariate Cox regress analysis suggested that prophylactic intra-aortic balloon pump insertion did not influence the long-term prognosis after adjustment of Killips classification and diabetes history(P=0.917).Conclusion Prophylactic intra-aortic balloon pump insertion before primary p

关 键 词：ST段抬高型心肌梗死 主动脉内球囊反搏 急诊介入治疗 主要不良心脑血管事件 倾向匹配得分 

分 类 号：R5[医药卫生—内科学]