急性ST段抬高型心肌梗死患者直接经皮冠脉介入治疗术后住院期间发生心力衰竭的危险因素  

An analysis on risk factors of heart failure in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention during hospitalization

作　　者：黎德恩[1] 梅啸 李明琰[1] LI Deen;MEI Xiao;LI Mingyan(Department of Cardiology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 511447,China)

机构地区：[1]广州医科大学附属第二医院心内科,广州511447

出　　处：《实用医学杂志》2021年第13期1674-1677,1683,共5页The Journal of Practical Medicine

基　　金：广东省自然科学基金资助项目(编号:2015A030313451)。

摘　　要：目的探讨ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者直接经皮冠脉介入治疗(primary percutaneous coronary intervention,PPCI)术后住院期间发生心力衰竭heart料,分为HF组(n=58)和非HF组(n=60),分析各因素与HF的关系。结果 HF组患者糖尿病比例、多支病变比例、糖化血红蛋白、空腹血糖、BNP、cTnI峰值、Syntax评分、总缺血时间(TIT)均高于非HF组(P <0.05)。多因素logistic回归分析提示Syntax评分、多支病变、TIT是STEMI患者PPCI术后住院期间发生HF的独立危险因素(P <0.05),血红蛋白是保护因素。ROC分析提示Syntax评分、TIT可作为预测HF的指标,ROC曲线下面积为0.877、0.786,最佳诊断界值是18.5分、221.5 min,其敏感度为89.7%、91.4%,特异度为68.3%、55.0%。Syntax评分联合TIT的ROC曲线下面积为0.922。结论高Syntax评分、多支病变及TIT长的STEMI患者PPCI术后住院期间更易发生HF,血红蛋白是保护因素,Syntax评分及TIT联合对STEMI患者PPCI术后住院期间发生心力衰竭的预测价值较高。Objective To explore the risk factors of heart failure(HF)in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PPCI)during hospitalization.Methods The medical data on 118 patients with STEMI who had undergone PPCI from June 2018 to May 2020 were collected in our hospital.The patients were divided into HF group(n=58)and non-HF group(n=60).The relationship between the influencing factors and the occurrence of HF was analyzed.Results The percentage of diabetes and multi-vessel lesions,and levels of HbA1c,fasting blood glucose,BNP and cTnI peak were significantly higher in HF group than in non-HF group(P<0.05).The Syntax score was significantly higher and the total ischemic time(TIT)was markedly longer in HF group than in non-HF group(P<0.05 for both comparisons).The multivariate binary logistic regression analysis showed that Syntax score,multi-vessel lesions,and TIT were independent risk factors of HF in patients with STEMI during hospitalization after PPCI(P<0.05),whereas hemoglobin was a protective factor of HF.The ROC curve showed that Syntax score and TIT could be used as predictors of HF.The AUC were 0.877 and 0.786,the best cut-off point was 18.5 points and 221.5 min,the sensitivity was 89.7%and 91.4%,and the specificity was 68.3%and 55.0%.Syntax score combined with TIT was also used as predictor of HF,and the AUC was 0.922.Conclusion sPatients with higher Syntax score,multi-vessel lesions,and longer TIT were more likely to develop HF during hospitalization after PPCI.Hemoglobin was a protective factor.Combination of Syntax score with TIT had higher predictive value for HF patients with STEMI after PPCI during hospitalization.

关 键 词：急性ST抬高型心肌梗死 SYNTAX评分 总缺血时间 心力衰竭 

分 类 号：R541.4[医药卫生—心血管疾病]