肾素-血管紧张素系统抑制对经皮冠状动脉介入治疗成功的晚期急性ST段抬高型心肌梗死的影响  

The clinical effect of renin-angiotensin system inhibition on outcomes of successful percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作　　者：董强 Dong Qiang(Department ofCardiology,Tongmei Group General Hospital,Shanxi037000,China)

机构地区：[1]同煤集团总医院心内科,大同037000

出　　处：《中国药物与临床》2020年第18期2994-2997,共4页Chinese Remedies & Clinics

摘　　要：目的研究抑制肾素-血管紧张素系统(RAS)是否会在晚期梗死(IRA)经皮冠状动脉介入治疗(PCI)成功的患者中有更好的临床结果。方法选择2013年1月至2018年12月669例晚期急性ST段抬高型心肌梗死(STEMI)患者接受经皮冠状动脉介入(PCI)成功。根据患者出院时是否服用了肾素-血管紧张素系统(RAS)抑制剂分为2组:试验组(RAS抑制剂,556例)和对照组(无RAS抑制剂,113例)。结果在1年的随访中,71例(10.6%)患者发生了严重的心脏不良事件(MACE),包括心性死亡和心肌梗死。实验组MACE发生率明显降低[危险比0.34,95%CI(0.199,0.588,P=0.001)]。试验组分析中,RAS抑制剂在男性、有高血压或糖尿病病史的患者中是有益的,甚至在左心室射血分数(LVEF)≥40%的患者中也是有益的。在超声心动图数据中,实验组在LVEF和左室收缩期末容积变化方面有更好的表现。结论在晚期STEMI患者中,RAS抑制剂改善了PCI预后的临床结果,即使是在LVEF相对低的患者中也有效果。Objective To investigate whether inhibition of the renin-angiotensin system(RAS)leads to better clinical outcomes in patients with advanced infarction(IRA)after successful percutaneous coronary intervention(PCI).Methods Between January 2013 and December 2018,669 patients with advanced acute ST-elevation myocardial infarction(STEMI)underwent PCI successfully.The patients were divided into two groups based on whether they were taking RAS inhibitors at discharge:the study group(RAS inhibitors,n=556)and the control group(no RAS inhibitors,n=113).Results During the one-year follow-up,71 patients(10.6%)developed severe adverse cardiac events(MACE),including cardiac death and myocardial infarction.The incidence of MACE in the study group was significantly lower[hazard ratio 0.34,95%CI(0.199,0.588),P=0.001)].Analysis of the study group showed that RAS inhibitors were beneficial in men,patients with a history of hypertension or diabetes,and even in patients with left ventricular ejection fraction(LVEF)≥40%.In echocardiographic data,the experimental group performed better in TERMS of LVEF and volume change at the end of left ventricular contraction.Conclusion RAS inhibitors improve the clinical outcome of PCI in patients with advanced STEMI patients,even in those with relatively low LVEF.

关 键 词：肾素-血管紧张素系统 心肌梗死 预后 心肌血管再生 

分 类 号：R542.22[医药卫生—心血管疾病]