急性STEMI患者早期左心室室壁瘤合并左心室血栓的相关因素分析  

Related factors of left ventricular thrombus formation within two weeks in patients with acute ST-segment elevation myocardial infarction and left ventricular aneurysm

作　　者：郭影影 赵肸 王璐[1] 赵晓燕[1] Guo Yingying;Zhao Xi;Wang Lu;Zhao Xiaoyan(Department of Cardiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,450052

出　　处：《中华心血管病杂志》2021年第4期360-367,共8页Chinese Journal of Cardiology

基　　金：国家重点研发计划(2018YFC1312505)。

摘　　要：目的:分析急性ST段抬高型心肌梗死(STEMI)患者早期左心室室壁瘤(LVA)合并左心室血栓(LVT)的相关因素。方法:本研究为回顾性研究。选取2014年1月至2020年6月于郑州大学第一附属医院心血管内科住院的急性STEMI早期发生LVA患者,根据是否合并LVT分为LVT组和无LVT组。收集并比较两组患者临床资料、超声心动图资料、冠状动脉造影和治疗方案,并对接受急诊经皮冠状动脉介入治疗(PCI)的LVT组和无LVT组患者进行亚组分析,比较两组患者发病至入院时间、入院至球囊扩张时间、发病至球囊扩张时间差异。采用多因素logistic回归分析急性STEMI患者早期LVA合并LVT的相关因素,并绘制森林图显示各个指标效应大小。结果:共入选144例患者,LVT组患者52例(36.1%),年龄(56.4±11.2)岁,男性46例(88.5%);无LVT组92例(63.9%),年龄(61.7±11.5)岁,男性73例(79.3%)。与无LVT组相比,LVT组患者较年轻,贫血、大量饮酒史、慢性肾脏病史、左心室射血分数(LVEF)≤40%、术前血流心肌梗死溶栓(TIMI)0级、术后血流TIMI≤2级比例均较高,心绞痛病史、冠状动脉侧支循环建立、急诊PCI或静脉药物溶栓比例均较低( P均<0.05)。两组患者接受抗血小板治疗及抗凝治疗的比例差异均无统计学意义( P均>0.05)。急诊PCI治疗的患者亚组分析显示两组发病至入院时间、入院至球囊扩张时间、发病至球囊扩张时间差异无统计学意义( P均>0.05)。多因素logistic回归分析和森林图显示大量饮酒史( OR=6.982,95% CI 1.501~32.469, P=0.013)、贫血( OR=3.373,95% CI 1.075~10.585, P=0.037)、LVEF≤40%( OR=3.016,95% CI 1.027~8.859, P=0.045)、术前血流TIMI 0级( OR=3.311,95% CI 1.214~9.029, P=0.019)与STEMI早期合并LVA患者发生LVT风险增加相关,而心绞痛病史( OR=0.159,95% CI 0.058~0.441, P<0.001)、冠状动脉侧支循环建立( OR=0.189,95% CI 0.053~0.673, P=0.010)、急诊PCI或静脉药物溶栓治疗( OR=0.252,95% CI 0.093~0.68Objective To investigate the related factors of left ventricular thrombus(LVT)formation within two weeks in patients with acute ST-segment elevation myocardial infarction(STEMI)and left ventricular aneurysm(LVA).Methods Consecutive inpatients with acute STEMI and left ventricular aneurysm,hospitalized from January 2014 to June 2020 in the First Affiliated Hospital of Zhengzhou University,were enrolled in this retrospective study.Patients were divided into LVT group and non-LVT group according to the presence or absence of LVT.The clinical data,echocardiography findings,coronary angiography and treatments were compared between the two groups.Subgroup analysis was performed on the patients receiving primary percutaneous coronary intervention(PCI).Onset to door,door to balloon,onset to balloon time were also compared.Multivariate logistic regression was used to analyze the related factors of LVT formation early post STEMI in enrolled patients.The effects of each index in multivariate logistic regression analysis were illustrated in the forest plot.Results A total of 144 patients were included,there were 52 cases(36.1%)in LVT group,the age was(56.4±11.2)years,and 46(88.5%)cases were male.There were 92 cases(63.9%)in non-LVT group,the age was(61.7±11.5)years,and there were 73(79.3%)males in this group.The patients in LVT group were younger than those in non-LVT group,the proportion of anemia,history of heavy drinking,history of chronic kidney disease,left ventricular ejection fraction(LVEF)≤40%,preoperative thrombosis in myocardial infarction(TIMI)blood flow grade 0 and postoperative TIMI blood flow grade≤2 were significantly higher in LVT group than those in non-LVT group(all P<0.05).The incidence of history of angina,collateral circulation of the coronary arteries,primary PCI or venous thrombolysis were significantly lower in LVT group than those in non-LVT group(all P<0.05).The percentage of anti-platelet therapy and anticoagulant therapy was similar between the two groups(all P˃0.05).Subgroup analysis in pa

关 键 词：心肌梗死 左心室室壁瘤 左心室血栓 

分 类 号：R542.22[医药卫生—心血管疾病]