Gensini评分在经完全血运重建急性ST段抬高型心肌梗死患者预后中的预测价值  

Predictive value of Gensini score in patients with acute ST-segment elevation myocardial infarction who underwent complete revascularization

作　　者：李晓涛 黄超联[1] 陈晓杰[1] 杨大为[1] 黄媛媛 杨玉红[1] 梁春玲[1] 张辰浩[1] Li Xiaotao;Huang Chaolian;Chen Xiaojie;Yang Dawei;Huang Yuanyuan;Yang Yuhong;Liang Chunling;Zhang Chenhao(Department of Emergency,Wang Jing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院急诊科,北京100102

出　　处：《中国心血管杂志》2023年第5期411-416,共6页Chinese Journal of Cardiovascular Medicine

基　　金：首都卫生发展科研专项(首发2022-1-4161)。

摘　　要：目的探讨在经完全血运重建治疗的急性ST段抬高型心肌梗死(STEMI)患者中,Gensini评分对临床预后的影响。方法回顾性纳入2017年1月至2019年12月在中国中医科学院望京医院经分期完全血运重建治疗的急性STEMI患者212例,根据Gensini评分三分位距将患者分为3组(Gensini评分≤48组77例,48<Gensini评分<82组72例,Gensini评分≥82组63例)。研究主要终点为术后2年的主要不良心血管事件(MACE,包括全因死亡、再发心肌梗死和缺血驱动的血管血运重建)发生情况,次要终点包括构成MACE的单独不良事件、心原性死亡和支架血栓发生情况。多变量Cox回归分析评估Gensini评分对2年随访期间临床结局的预测价值。结果3组平均随访时间比较,差异无统计学意义[(23.1±2.2)个月、(23.5±3.2)个月和(22.4±3.3)个月,P=0.084]。随访期间,MACE发生率在3组间比较差异有统计学意义(7.8%、16.7%和25.4%,P=0.018);全因死亡率在Gensini评分≥82组最高(9.5%),但3组间比较差异无统计学意义(P=0.077);而再发心肌梗死、缺血驱动的血管血运重建、心原性死亡和支架血栓发生率在3组间比较差异均无统计学意义(均为P>0.05)。多因素Cox回归分析显示,吸烟史(HR:4.660,95%CI:1.781~12.194,P=0.002)、既往经皮冠状动脉介入治疗史(HR:5.336,95%CI:1.608~17.702,P=0.006)、左心室射血分数(HR:0.920,95%CI:0.883~0.958,P<0.001)(此为保护性因素)、平均靶病变长度(HR:1.070,95%CI:1.020~1.122,P=0.005)和Gensini评分(HR:1.016,95%CI:1.003~1.030,P=0.011)为术后2年MACE发生的预测因素。结论在经完全血运重建治疗的急性STEMI患者中,Gensini评分较高者的MACE发生率明显高于Gensini评分较低者,Gensini评分可作为术后2年MACE发生的独立预测因素。Objective To investigate the value of Gensini score in predicting clinical outcomes of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing complete revascularization.Methods A total of 212 patients with acute STEMI underwent staged complete revascularization in Wang Jing Hospital of China Academy of Chinese Medical Sciences from January 2017 to December 2019.Patients were divided into three groups according to the tertile of Gensini score(Gensini score≤48 group/77 cases,48<Gensini score<82 group/72 cases and Gensini score≥82 group/63 cases).The primary endpoint of the study was major adverse cardiac events(MACE),including all-cause death,recurrent myocardial infarction,and ischemia-driven vascular revascularization during the 2-year follow-up period,and secondary endpoints included separate clinical adverse events that constituted MACE,cardiac death,and stent thrombosis.Multivariate Cox regression analyses were performed to assess the predictive value of the Gensini score for clinical outcomes during 2-year follow-up.Results There was no significant difference in the mean follow-up period among the three groups[(23.1±2.2)months,(23.5±3.2)months,and(22.4±3.3)months,P=0.084].After 2-year follow-up,there was a statistically significant difference in the incidence of MACE among the three groups(7.8%,16.7%and 25.4%,P=0.018).All-cause mortality rate was highest in the Gensini score≥82 group(9.5%)without significant difference among the three groups(P=0.077).Incidence of recurrent myocardial infarction,ischemia-driven vascular revascularization,cardiac mortality,and stent thrombotic events did not show significant differences among the three groups(all P>0.05).Multivariate Cox regression analysis showed that smoking history(HR:4.660,95%CI:1.781-12.194,P=0.002),previous percutaneous coronary intervention(HR:5.336,95%CI:1.608-17.702,P=0.006),left ventricular ejection fraction(HR:0.920,95%CI:0.883-0.958,P<0.001)(this is a protective factor),mean target lesion length(HR:1.070,95%CI:1.020

关 键 词：急性ST段抬高型心肌梗死 完全血运重建 经皮冠状动脉介入治疗 GENSINI评分 预后 

分 类 号：R542.22[医药卫生—心血管疾病]