梗死前心绞痛对STEMI患者PCI后主要不良心血管事件及慢血流的影响  

Influence of pre-infarction angina pectoris on major adverse cardiovascular events and coronary slow flow in patients with ST-segment elevation myocardial infarction after PCI

作　　者：成力 胡建波 李小庆 Cheng Li;Hu Jianbo;Li Xiaoqing(Department of Cardiovascular Medicine,Xinqiao Hospital,Army Medical University,Chongqing 400037,China.)

机构地区：[1]陆军军医大学附属新桥医院心血管内科,重庆400037 [2]重庆北部宽仁医院心血管内科,重庆400000

出　　处：《中国循证心血管医学杂志》2022年第1期70-74,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：重庆市基础科学与前沿技术研究项目(cstc2017jcyjAX0234)。

摘　　要：目的探讨心肌梗死前心绞痛(PAP)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后主要不良心血管事件(MACE)及冠状动脉慢血流(CSF)的影响。方法选取陆军军医大学附属新桥医院心血管内科自2018年1月~2019年12月收治的227例择期行PCI治疗STEMI患者,根据是否有PAP分为有PAP组(n=132)和无PAP组(n=95)。收集两组患者临床基线资料及常规实验指标,对比记录两组患者PCI后CSF发生率及随访6个月内MACE的发生率,Logistics回归分析术后CSF影响因素。结果两组患者TIMI分级、Killip分级、ST段回落率对比差异明显(P<0.05),无PAP组TIMI分级1、2级比例和Killip分级Ⅱ级、Ⅲ级、Ⅳ级比例及ST段回落率<30%、30%~70%比例多于有PAP组;无PAP组侧支循环形成比例和左心室射血分数(LVEF)明显低于有PAP组,术后CSF发生率和血清脑钠肽(BNP)、肌红蛋白(Mb)、肌酸激酶同工酶(CKI)、心肌肌钙蛋白Ⅰ(cTnI)、D-二聚体(D-D)水平和MACE发生率明显高于有PAP组(P<0.05);多因素Logistics回归分析显示,就诊至球囊扩张时间(OR=0.998,95%CI:0.997~1.000)、cTnI(OR=1.022,95%CI:1.003~1.041)、D-D(OR=1.062,95%CI:1.018~1.106)为CSF独立危险因素,PAP(OR=2.518,95%CI:1.220~5.197)为独立保护因素(P<0.05)。结论PAP可减少STEMI患者PCI后MACE及CSF发生,促进血运重建,可作为STEMI患者预后判断指标。Objective To investigate the influence of pre-infarction angina pectoris(PAP)on major adverse cardiovascular events(MACE)and coronary slow flow(CSF)in patients with ST-segment elevation myocardial infarction(STEMI)after PCI.Methods STEMI patients undergone PCI(n227)were chosen from Department of Cardiovascular Medicine in Xinqiao Hospital of Army Medical University from Jan.2018 to Dec.2019,and divided into PAP group(n=132)and non-PAP group(n=95).The clinical baseline materials and routine laboratory indexes were collected in 2 groups.The incidence rate of CSF after PCI and incidence rate of MACE within 6-month follow-up period were compared and recorded in 2 groups.The influence factors of CSF were analyzed by using multi-factor Logistics regression analysis.Results There were significant differences in TIMI classification,Killip classification and ST-segment reduction rate between 2 groups(P<0.05).The percentages of patients with grade 1 and grade 2 in TIMI classification,gradeⅡ,gradeⅢand gradeⅣin Killip classification and ST-segment reduction rate<30%and ST-segment reduction rate=30%-70%were higher in non-PAP group than those in PAP group.The percentages of collateral circulation and LVEF were significantly lower in non-PAP group than those in PAP group.The incidence rate of CSF and levels of BNP,Mb,CKI,cTnI and D-D,and incidence rate of MACE were significantly higher in non-PAP group than those in PAP group(P<0.05).The results of multi-factor Logistics regression analysis showed that door to balloon(OR=0.998,95%CI:0.997~1.000),cTnI(OR=1.022,95%CI:1.003~1.041),and D-D(OR=1.062,95%CI:1.018~1.106)were independent risk factors of CSF.PAP(OR=2.518,95%CI:1.220~5.197)was an independent protective factor of CSF(P<0.05).Conclusion PAP can reduce the incidence rates of MACE and CSF and improve revascularization in STEMI patients after PCI,which can be taken as a prognostic indicator for STEMI patients.

关 键 词：急性ST段抬高型心肌梗死 心绞痛症状 经皮冠状动脉介入术 主要不良心血管事件 冠状动脉慢血流 

分 类 号：R542.22[医药卫生—心血管疾病]