老年急性前壁心肌梗死急诊经皮冠脉介入术后早期左心室血栓形成的预测因素  

Predictors of early left ventricular thrombus in elderly patients with anterior acute ST segment elevation myocardial infarction receiving emergency percutaneous coronary intervention

作　　者：呼日乐巴特尔 吴红丽[1] 刘雪婷 李志鹏 杨志鹏[1] 王洪军[1] 辛琦 陈宏魏 Hurilebater;WU Hongli;LIU Xueting;LI Zhipeng;YANG Zhipeng;WANG Hongjun;XIN Qi;CHEN Hongwei(Department of Cardiovascu lar Medicine,the Affiliated Hospital of Inner Mongolia University for Nationalities,Tongliao 028000,China)

机构地区：[1]内蒙古民族大学附属医院心血管内科,内蒙古通辽028000

出　　处：《实用医学杂志》2023年第17期2230-2235,共6页The Journal of Practical Medicine

摘　　要：目的探讨老年急性前壁心肌梗死患者急诊经皮冠脉介入术(percutaneous coronary intervention,PCI)后早期左心室附壁血栓(left ventricular thrombus,LVT)的预测因素。方法连续入选2020年1月至2023年1月就诊于我院,行急诊PCI老年前壁心肌梗死患者435例,住院期间发现LVT形成40例为LVT组,从非LVT患者中按照性别和年龄1∶2匹配80例患者为非LVT组,最终120例患者纳入本研究。探讨LVT的危险因素,分析LVT的预测因素。结果LVT发生率为9.2%,出院时持续ST段抬高、左心室射血分数(left ventricular ejection fraction,LVEF)≤0.40、室壁瘤、症状发作至球囊扩张时间(symptom to balloom,STB)≥8 h、术后TIMI血流<3级和D-二聚体/纤维蛋白原比值(D-dimer to fibrinogen ratio,DFR)升高是LVT形成的危险因素(P<0.05)。ROC曲线分析显示DFR≥0.30对LVT预测的敏感度为72.5%,特异度为78.7%(AUC=0.834,P<0.01)。结论出院时持续ST段抬高、LVEF≤0.40、室壁瘤、STB≥8 h、术后TIMI血流<3级和DFR升高是早期LVT形成的独立预测因素。DFR对LVT具有良好的预测价值。Objective To explore the predictive factors of earlyleft ventricular mural thrombus(LVT)after emergency PCI in elderly patients with acute anterior myocardial infarction.Methods A total of 435 elderly patients with anterior myocardial infarction who underwent emergency PCI in our hospital from January 2020 to January 2023 were continuously included in the study.Fortypatients with LVT formation during hospitalization were selected as LVT group;another eighty patients with a gender to age ratio of 1:2from non LVT patients asnon-LVT group.The risk factors and predictive factors of LVT were explored.Results The incidence of LVT was 9.2%.Continuous ST segment elevation at discharge,LVEF≤0.40,ventricular aneurysm,STB≥8 hours,postoperative TIMI blood flow<grade 3,and increased D-dimer/fibrinogen ratio(DFR)were risk factors for LVT formation(P<0.05).ROC curve analysis showed that DFR≥0.30 had a sensitivity of 72.5%and a specificity of 78.7%for predicting LVT(AUC=0.834,P<0.01).Conclusion Continuous ST segment elevation at discharge,LVEF≤0.40,ventricular aneurysm,STB≥8 hours,postoperative TIMI blood flow<grade 3,and increased DFR are independent predictive factors for early LVT.DFR has good predictive value for LVT.

关 键 词：老年 急性前壁心肌梗死 左心室血栓形成 D-二聚体/纤维蛋白原比值 

分 类 号：R54[医药卫生—心血管疾病]