急性心肌梗死合并心源性休克患者行急诊经皮冠状动脉介入治疗院内死亡危险因素  

Risk factors for in-hospital mortality in patients with acute myocardial infarction complicated by cardiogenic shock undergoing primary percutaneous coronary intervention

作　　者：周生辉 柳子静[1] 李紫旋 郝明辉[1] 吴永霞 张利彬[1] 王宇平[1] 王国忠[1] 徐荣[1] 郭金成[1] ZHOU Sheng-hui;LIU Zi-jing;LI Zi-xuan;HAO Ming-hui;WU Yong-xia;ZHANG Li-bin;WANG Yu-ping;WANG Guo-zhong;XU Rong;GUO Jin-cheng(Department of Cardiology,Bejing Luhe hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院心内科,北京市101149

出　　处：《中国心血管病研究》2022年第7期602-607,共6页Chinese Journal of Cardiovascular Research

基　　金：首都卫生发展科研专项(首发2022-2-7086)。

摘　　要：目的探讨急性心肌梗死(AMI)合并心源性休克(CS)患者行急诊经皮冠状动脉介入治疗(pPCI)院内死亡危险因素。方法连续入选2017年12月至2020年6月在首都医科大学附属北京潞河医院接受pPCI的AMI合并CS患者122例,根据患者转归情况分为院内存活组(75例)和院内死亡组(47例),采用二分类logistic分析AMI合并CS患者行pPCI院内死亡的危险因素。结果ST段抬高型心肌梗死(STEMI)合并CS 112例,非ST段抬高型心肌梗死(NSTEMI)10例,院内病死率38.5%。多元回归分析显示,年龄>60岁(OR=4.020,95%CI 1.235~13.083,P=0.021)、冠状动脉多支血管病变(OR=3.611,95%CI 1.196~10.899,P=0.023)、入院时动脉乳酸>5.0 mmol/L(OR=3.007,95%CI 1.085~8.334,P=0.034)、慢性肾功能不全(CKD)≥3期(OR=6.953,95%CI 2.377~20.343,P<0.001)、左心室射血分数(LVEF)<50%(OR=4.128,95%CI 1.396~12.200,P=0.010)、气管插管(OR=4.723,95%CI 1.306~17.077,P=0.018)是患者院内死亡的独立危险因素。结论年龄>60岁、冠状动脉多支血管病变、入院时动脉乳酸>5.0 mmol/L、CKD≥3期、LVEF<50%、气管插管,是AMI合并CS患者行pPCI院内死亡危险因素。Objective To evaluate the risk factors of in-hospital mortality in the patients with acute myocardial infarction(AMI)complicated by cardiogenic shock(CS)undergoing primary percutaneous coronary intervention(pPCI).Methods A total of 122 patients with AMI complicated with CS who received pPCI in Beijing Luhe Hospital,Capital Medical University from December 2017 to June 2020 were included.The patients were divided into in-hospital survival group(n=75)and in-hospital death group(n=47).Multivariate statistical analysis with logistic regression was used to analyze the clinical and procedural variables to determine the risk factors for hospital mortality.Results Among 122 AMI with CS patients,there were 112 with ST-segment elevation AMI and 10 with non-ST-segment elevation AMI.The overall hospital mortality was 38.5%.Logistic multivariate analysis showed that the age>60 years old(OR=4.020,95%CI 1.235-13.083,P=0.021),multivessel coronary artery disease(OR=3.611,95%CI 1.196-10.899,P=0.023),arterial lactate>5.0 mmol/L at admission(OR=3.007,95%CI 1.085-8.334,P=0.034),stage 3 or more chronic kidney disease(CKD)(OR=6.953,95%CI 2.377-20.343,P<0.001),left ventricular ejection fraction(LVEF)<50%(OR=4.128,95%CI 1.396-12.200,P=0.010)and endotracheal intubation(OR=4.723,95%CI 1.306-17.077,P=0.018)were the independent risk factors for in-hospital death.Conclusion The age>60 years old,coronary artery multi-vessel lesions,arterial lactate>5.0 mmol/L at admission,stage 3 or more CKD,LVEF<50%,endotracheal intubation were the independent risk factors for the in-hospital mortality in the patients with AMI complicated by CS received pPCI.

关 键 词：经皮 介入治疗 急性心肌梗死 心源性休克 院内死亡 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]