入院血压与急性ST段抬高型心肌梗死患者介入术后及1年预后的关系  

The relationship between admission blood pressure and in-hospital and 1-year prognosis after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作　　者：张麟 王子健 卢霞[2] 甘丰[1] ZHANG Lin;WANG Zijian;LU Xia;GAN Feng(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核医学科

出　　处：《心肺血管病杂志》2023年第8期763-769,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市“培育计划”基金(PX2022025)。

摘　　要：目的:探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者在行直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)前的收缩压/舒张压与发生院内并发症及出院1年内的主要心血管不良事件(major adverse cardiovascular events,MACE)间的关系。方法:本研究纳入512例STEMI患者。根据入院收缩压及舒张压水平,采用四分位法分别分为四组:收缩压组-1 (<114mmHg,1mmHg=0.133kPa),收缩压组-2 (114~129mmHg),收缩压组-3 (130~148mmHg),收缩压组-4(≥149mmHg);舒张压组-1(<70mmHg),舒张压组-2(70~79mmHg),舒张压组-3(80~89mmHg),舒张压组-4(≥90mmHg)。比较不同血压分组的PPCI术后院内并发症及1年内MACE的发生率,描述血压与院内并发症之间的关系,并探讨PPCI术后发生院内并发症与1年内发生MACE的影响因素。结果:收缩压与院内并发症之间的关系呈“J”形,当SBP<105.1mmHg、SBP>145.5mmHg时发生院内并发症的风险开始升高;舒张压与院内并发症之间的关系呈“L”形,当DBP<58.3mmHg时发生院内并发症的风险开始升高。随访结果:单因素Cox回归分析显示收缩压、舒张压及脉压均不是1年内发生MACE的危险因素。结论:SBP<105.1mmHg、SBP>145.5mmHg、DBP<58.3mmHg可能是PPCI术后发生院内并发症的危险因素,但入院血压水平不是1年内发生MACE的危险因素。Objective:To investigate the relationship between SBP and DBP before primary percutaneous coronary intervention(PPCI)and the occurrence of in-hospital complications and major cardiovascular adverse events within one year of discharge in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:In this study,512 patients with acute STEMI admitted.According to the level of systolic blood pressure and diastolic blood pressure in the hospital,the quartile method is used.SBP groups 1(<114mmHg),SBP groups 2(114-129mmHg),SBP groups 3(130-148mmHg),SBP groups 4(≥149mmHg);DBP groups 1(<70mmHg),DBP groups 2(70-79mmHg),DBP groups 3(80-89mmHg),DBP groups 4(≥90mmHg).To compare the incidence of in-hospital complications and MACE within 1 year after PPCI in different blood pressure groups,and describe the relationship between blood pressure and in-hospital complications.Finally,to explore the influencing factors of in-hospital complications and MACE within 1 year after PPCI.Results:The relationship between SBP and in-hospital complications is"J"shaped,when SBP<105.1mmHg and SBP>145.5mmHg,the risk of in-hospital complications begins to increase.The relationship between DBP and in-hospital complications is"L"shaped,when DBP<58.3mmHg,the risk of in-hospital complications begins to increase.The follow-up results showed that univariate Cox regression analysis showed that SBP,DBP and PP were not risk factors for MACE within 1 year.Conclusions:SBP<105.1mmHg,SBP>145.5mmHg,DBP<58.3mmHg may be the risk factors for in-hospital complications after PPCI,but admission blood pressure is not risk factors for MACE within 1 year.

关 键 词：血压 急性ST段抬高型心肌梗死 直接经皮冠状动脉介入治疗 院内并发症 主要心血管不良事件 

分 类 号：R54[医药卫生—心血管疾病]