梗死前心绞痛对急性STEMI患者的预后及急诊PCI术后慢血流的影响  

Correlation study of prodromal angina pectoris in patients with acute ST-segment elevation myocardial infarction and slow blood flow after emergency PCI

作　　者：马飞虹 乔增勇[2] MA Feihong;QIAO Zengyong(Anhui University of Science and Technology,Huainan,Anhui,232000,China;Department of Cardiology,South District,The Sixth Peoples Hospital,Shanghai Jiaotong University)

机构地区：[1]安徽理工大学,安徽淮南232000 [2]上海交通大学附属第六人民医院南院心内科

出　　处：《临床心血管病杂志》2020年第9期794-799,共6页Journal of Clinical Cardiology

基　　金：上海市奉贤区科学技术委员会重大课题资助(No:20170703)。

摘　　要：目的:观察有无梗死前心绞痛(PAP)对急性ST段抬高型心肌梗死(STEMI)患者在急诊冠状动脉介入(PCI)术后的短期预后、主要不良心血管事件(MACE)及慢血流(CSF)发生方面的保护作用。方法:采用回顾性分析的方法,共纳入633例STEMI患者,根据有无PAP分为有PAP组和无PAP组,记录患者TIMI分级、术后校正的TIMI帧数计数(cTFC)、病变血管支数、有无CSF等术中情况,术后记录患者肌钙蛋白-I、肌红蛋白、肌酸激酶同工酶、脑钠肽(BNP)峰值浓度、左室射血分数(LVEF)、ST段回落率(SUM-STR)及MACE等。结果:有PAP组恶性心律失常事件及术后心绞痛、死亡等MACE例数均少于无PAP组(P<0.05);急诊PCI术中TIMI血流分级、cTFC、CSF、侧支循环有PAP组均优于无PAP组(P<0.05);肌钙蛋白-I、肌酸激酶同工酶、肌红蛋白、BNP峰值浓度有PAP组均小于无PAP组(P<0.05);LVEF有PAP组优于无PAP组(P<0.05)。PAP与急诊PCI术中CSF的发生有相关性(OR=0.185,95%CI:0.074~0.462,P=0.000)。结论:PAP对STEMI患者的短期预后和MACE发生具有重要的保护作用,并降低急诊PCI术中CSF的发生率,保证了有效心肌灌注,对临床治疗判断STEMI患者预后和成功血运重建(PCI或溶栓)有重要的预测价值。Objective:To observe whether prodromal angina pectoris(PAP) protects patients with acute ST-segment elevation myocardial infarction(STEMI) in short-term prognosis after emergency percutaneous coronary intervention(PCI),major adverse cardiovascular events(MACE),and slow blood flow(CSF).Method:In the retrospective analysis,633 patients with STEMI were collected and the patients were divided into the PAP groups and the non-PAP groups.The patient’s TIMI grade,postoperative cTFC(corrected TIMI frame count),number of diseased vessels,and the presence or absence of CSF were recorded.Postoperative patient’s cTn-I,BNP,LVEF,SUM-STR(ST segment fall rate) and various MACEs were recorded and analyzed.Result:The malignant arrhythmia,postoperative angina pectoris and death were lower in the PAP group than in the non-PAP group(P<0.05).Intraoperative TIMI blood flow classification,cTFC,CSF,collateral circulation in the PAP group were better than the non-PAP group(P<0.05).The cTn-I,creatine kinase isoenzyme,myoglobin,BNP peak concentration in the PAP group were less than the non-PAP group(P<0.05),the LVEF values in the PAP group were better than the non-PAP group(P<0.05).The PAP was associated with the occurrence of CSF during emergency PCI(OR=0.185,95% CI =0.074-0.462,P=0.000).Conclusion:The PAP has a protective effect on the short-term prognosis of STEMI patients.

关 键 词：梗死前心绞痛 急性ST段抬高型心肌梗死 有效心肌灌注 预后 慢血流 

分 类 号：R541.4[医药卫生—心血管疾病]