急性ST段抬高型心肌梗死患者冠脉自发性再通及其预后因素分析  

Analysis of coronary recanalization and its prognostic factors in patients with acute ST-segment elevation myocardial infarction

作　　者：闫玉峰 徐海梅[1] 赵莹莹[1] 赵原艺 郑亚国 林松[1] YAN Yufeng;XU Haimei;ZHAO Yingying;ZHAO Yuanyi;ZHENG Yaguo;LIN Song(Department of Cardiology,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210006;Department of Cardiology,Xiangshui People’s Hospital,Yancheng 224600,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心内科,江苏南京210006 [2]响水县人民医院心内科,江苏盐城224600

出　　处：《南京医科大学学报（自然科学版）》2023年第11期1535-1543,共9页Journal of Nanjing Medical University(Natural Sciences)

基　　金：南京市卫生局重点项目(ZKX16049)。

摘　　要：目的:探究急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者冠脉自发性再通(spontaneous recanalization,SR)的影响因素及其对长期预后的影响。方法:连续纳入2011年7月—2019年4月于南京市第一医院诊断为STEMI并行急诊冠脉介入治疗的患者,根据冠脉造影结果分为非SR组(TIMI血流0~1级)和SR组(TIMI血流2~3级),收集两组患者一般临床资料、实验室检查结果、冠脉造影及药物治疗数据,主要观察终点为全因死亡。结果:共纳入1124例STEMI患者,其中包括SR组272例(24.2%),非SR组852例(75.8%)。SR组患者高血压比例、肌酸激酶同工酶(cre-atine kinase isoenzyme-MB,CK-MB)峰值、肌酐、尿酸、血栓抽吸比例、主动脉内球囊反搏(intra-aortic balloon pump,IABP)植入及院内死亡率明显低于非SR组,而左心室射血分数高于非SR组。多因素Logistic回归分析显示合并高血压不利于SR发生(OR=0.744,95%CI:0.561~0.985,P=0.039)。随访时间为79(61,101)个月,124例患者出现全因死亡。Kaplan-Meier曲线显示,SR组和非SR患者生存时间差异无统计学意义(log-rank P=0.182)。多因素COX回归分析显示,年龄、Killip分级、肌酐、院内IABP植入、左心室射血分数、单支病变、替格瑞洛、β受体阻滞剂为STEMI患者全因死亡的独立预测因子。结论:近1/4的STEMI患者急诊冠脉介入治疗前发生SR,合并高血压不利于SR发生,而长期随访显示SR并未降低STEMI患者的全因死亡率。Objective:To investigate the factors of spontaneous recanalization(SR)and its impact on long-term prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:The study consecutively enrolled patients diagnosed with STEMI and underwent primary percutaneous coronary intervention in Nanjing First Hospital from July 2011 to April 2019.Patients were divided into the SR group(TIMI flow grade 0-1)and the non-SR group(TIMI flow grade 2-3)based on the results of coronary angiography.The data of the two groups were collected,including general clinical data,laboratory test results,coronary angiography and drug treatment.The primary endpoint was all-cause death.Results:Total 1124 patients were enrolled,including 272 patients(24.2%)in the SR group and 852 patients(75.8%)in the non-SR group.Patients with SR were significantly decreased in proportions of hypertension,creatine kinase isoenzyme-MB(CK-MB)peak value,creatinine levels,uric acid levels,thrombus vessel aspiration rate,intra-aortic balloon pump(IABP)implantation rate and in-hospital mortality,compared with the non-SR group.However,the left ventricular ejection fraction was higher in the SR group than in the non-SR group.Multivariate logistic regression analysis showed that hypertension was a disadvantage for SR(OR=0.744,95%CI:0.561-0.985,P=0.039).The follow-up period was 79(61,101)months,during which 124 patients occurred all-cause mortality.Kaplan-Meier curves indicated that there was no significant difference in survival time between the SR group and the non-SR group(log-rank P=0.182).Multivariate COX regression analysis revealed that age,Killip classification,creatinine,in-hospital IABP implantation,left ventricular ejection fraction,single-vessel disease,ticagrelor andβ-blocker were independent predictors of all-cause death in STEMI patients.Conclusion:Nearly 1/4 of STEMI patients occur SR before the primary percutaneous coronary intervention.Hypertension is an unfavorable factor for SR occurrence.However,long-term follow-up reveals

关 键 词：急性ST段抬高型心肌梗死 冠脉自发性再通 预后 

分 类 号：R542.2[医药卫生—心血管疾病]