PCI术后1年再发AMI患者预后影响因素研究  

Clinical study of prognostic factors of patients with recurrent AMI after 1 year in PCI

作　　者：张海军[1] 陈会校[1] 靳芳[2] 李文娟[1] 赵沙沙[1] 张宝山 Zhang Haijun;Chen Huixiao;Jin Fang;Li Wenjuan;Zhao Shasha;Zhang Baoshan(Department of Cardiology,Handan first hospital,Handan 056002,China)

机构地区：[1]邯郸市第一医院心内四科,邯郸056002 [2]邯郸市第一医院耳鼻喉头颈外科,邯郸056002 [3]邯钢医院心内科,邯郸056002

出　　处：《中国循证心血管医学杂志》2021年第7期811-814,818,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省卫生健康委科研基金项目(20171091)。

摘　　要：目的探讨经皮冠状动脉介入治疗(PCI)术后1年再发急性心肌梗死(AMI)患者预后影响因素。方法回顾性分析邯郸市第一医院心内科于2012年1月至2019年1月收治的PCI术后1年再发AMI患者658例的临床资料,入选患者均顺利完成冠状动脉(冠脉)造影,根据AMI靶病变再发是否与支架内血栓有关,分为支架内血栓组(n=480)与非支架内血栓组(n=178)。比较两组基线临床资料、冠脉造影指标、治疗及预后相关指标,采用Cox回归模型分析PCI术后1年再发AMI患者预后影响因素。结果支架内血栓组入院前接受单一抗血小板药物治疗比例显著低于非支架内血栓组(P<0.05),而支架内血栓组入院前停用抗血小板药物比例显著高于非支架内血栓组(P<0.05);支架内血栓组球囊扩张比例显著高于非支架内血栓组(P<0.05),而支架再次置入和药物治疗比例均显著低于非支架内血栓组(P<0.05);两组住院期间主要/次要终点事件、术后随访主要终点事件发生率及随访1年累积无主要终点事件率比较,差异均无统计学意义(P>0.05);支架内血栓组术后随访次要终点事件发生率和血运重建发生率显著高于非支架内血栓组(P<0.05);支架内血栓组随访1年累积无次要终点事件率显著低于非支架内血栓组(P<0.05);COX回归模型多因素分析结果显示,Killip分级、极晚期支架内血栓及术后TIMI分级均是PCI术后1年后再发AMI独立影响因素(P<0.05)。结论 PCI术后1年后再发AMI患者预后与Killip分级、极晚期支架内血栓及术后TIMI分级独立相关;其中,因支架内血栓导致再发AMI患者预后常较差,具有更高血运重建比例。Objective To investigate prognostic factors in patients with recurrent acute myocardial infarction(AMI)1 year after percutaneous coronary intervention(PCI).Methods A total of 658 consecutive AMI patients who were admitted to the Department of Cardiology,Handan First hospital from January 2012 to January 2019.All enrolled patients successfully received coronary angiography,and were divided into stent thrombosis group(n=480)and non stent thrombosis group(n=178)according to whether the recurrence of AMI target lesion was related to stent thrombus.Baseline clinical data,coronary angiography indexes,treatment-related indexes,and prognosis related indexes were compared between the two groups,and the Cox regression model was used to analyze the prognostic factors of AMI patients with recurrence 1 year after PCI.Results The proportion receiving single antiplatelet medication before admission was significantly lower in the stent thrombosis group than in the non stent thrombosis group(P<0.05),whereas the proportion discontinuing antiplatelet medication before admission was significantly higher in the stent thrombosis group than in the non stent thrombosis group(P<0.05).The proportion of balloon dilatation was significantly higher in the group with stent thrombosis than in the group without stent thrombosis(P<0.05),whereas the proportion with stent re placement and medical therapy was significantly lower in the group with stent thrombosis than in the group without stent thrombosis(P<0.05).There were no significant differences between the two groups in the incidence of the primary/secondary endpoint during hospitalization,the incidence of the primary endpoint at postoperative follow-up and the cumulative incidence free of the primary endpoint at 1 year of follow-up(P>0.05).The rates of the secondary end points of follow-up and revascularization at any time were significantly higher in the stent thrombosis group than in the non stent thrombosis group(P<0.05 for all comparisons).The cumulative rate of freedom from secondary en

关 键 词：PCI AMI 支架内血栓 预后 影响因素 

分 类 号：R542.22[医药卫生—心血管疾病]