ST段抬高与非ST段抬高型急性心肌梗死临床资料及预后的单中心研究  

A comparison of clinical profiles and prognostic differences between acute ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction:a retrospective single-centre study

作　　者：付坤 王进 王蓉[1] 陆蕙[1] 董芊汝 刘华东[1] 王婷婷 王西 郝蓬[2] FU Kun;WANG Jin;WANG Rong;LU Hui;DONG Qianru;LIU Huadong;WANG Tingting;WANG Xi;HAO Peng(Department of Cardiology,Beijing Aerospace General Hospital,Beijing 100076,China)

机构地区：[1]北京航天总医院心内科,100076 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科

出　　处：《心肺血管病杂志》2023年第6期523-527,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:对比分析急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)与非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者的临床特征和1年预后。方法:回顾性分析2019年9月至2021年3月,北京航天总医院诊断的238例急性心肌梗死患者,其中NSTEMI患者114例、STEMI患者124例,比较两组患者的临床资料以及术后1年预后。经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后1年不良心血管事件(major adverse cardiac event,MACE)定义为心律失常、再发心肌梗死、心力衰竭及死亡。结果:STEMI与NSETMI患者基线资料对比,年龄(62.7±14.5)vs.(66.3±11.5)岁,高血压(56.5%vs.65.8%),高脂血症(71%vs.84.2%),肾功能不全(3.2%vs.13.2%),心肌梗死病史(2.4%vs.9.6%),基线cTnI[0.2(0.02,1.5)vs.0.8(0.1,3.0)ng/mL],BNP[178.5(44.6,837.3)vs.477.0(157.7,1611.6)ng/L],LVEF[60.0(55.0,67.9)%vs.65.0(58.8,70.0)%],LVESD[32.0(28.8,38.0)vs.29.00(26.0,32.0)mm]等变量,差异有统计学意义(P均<0.05)。单因素Kaplan-Meier显示STEMI与NSETMI患者相比,两者1年MACE差异无统计学意义(Log Rank=0.247,P=0.619);Cox生存分析显示与NSTEMI为对比,两组1年MACE无显著差异(HR=1.527,95%CI:0.714~3.264,P=0.275)。校正其他危险因素,高脂血症,糖尿病史与1年MACE相关。STEMI组与NSTEMI组中相比,术后1年心功能变化差值无统计学意义(P>0.05)。结论:在本单中心回顾性研究中,STEMI与NSTEMI患者1年MACE事件及心功能变化差值差异无统计学意义;高脂血症,糖尿病史是影响AMI患者1年MACE发生的预测因素。Objective:To compare the clinical characteristics and 1-year prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)and non-ST-segment elevation myocardial infarction(NSTEMI).Methods:A total of 238 patients with acute myocardial infarction(AMI)in Beijing Aerospac General Hospital from September 2019 to March 2021,including 114 patients with NSTEMI and 124 patients with STEMI,were compared in terms of clinical data and prognosis at 1 year after percutaneous coronary intervention(PCI).Adverse cardiovascular events(MACE)at 1 year after percutaneous coronary intervention were defined as arrhythmia,recurrent infarction,heart failure,and death.Results:Baseline data of patients with STEMI vs.NSETMI were compared in terms of age(62.7±14.5)vs.(66.3±11.5)years,hypertension(56.5%vs.65.8%),hyperlipidemia(71%vs.84.2%),renal insufficiency(3.2%vs.13.2%),history of myocardial infarction(2.4%vs.9.6%),baseline cTNI[0.2(0.0,1.5)vs.0.8(0.1,3.0)]ng/mL,BNP[178.5(44.6,837.3)vs.477.0(157.7,1611.6)]ng/L,LVEF[60.0(55.0,67.9)%vs.65.0(58.8,70.0)%],and LVESD[32.0(28.8,38.0)vs.29.0(26.0,32.0)mm]were significantly different,all P<0.05.Univariate Kaplan-Meier showed no significant difference in 1-year MACE for STEMI compared to NSETMI patients(Log Rank=0.247,P=0.619);Cox survival analysis showed no significant difference in 1-year MACE between the two groups compared to NSTEMI(HR=1.527,95%CI:0.714-3.264,P=0.275).Correcting for other risk factors,hyperlipidaemia and a history of diabetes were associated with 1-year MACE;the difference in change in cardiac function at 1 year after PCI was not statistically significant in the STEMI group compared with the NSTEMI group(P>0.05).Conclusions:In this single-centre retrospective study,there was no significant difference according to 1-year MACE events and changes in cardiac function between patients with STEMI and NSTEMI;hyperlipidaemia,and a history of diabetes were independent predictors of 1-year MACE occurrence in patients with AMI.

关 键 词：急性心肌梗死 急性ST段抬高型心肌梗死 不良心血管事件 

分 类 号：R54[医药卫生—心血管疾病]