ST段抬高型心肌梗死伴左心室室壁瘤患者发病早期继发左心室血栓的危险因素大样本回顾性研究  

Large Sample Retrospective Study on Risk Factors of Secondary Left Ventricular Thrombosis In Early Stage of Patients with ST-Segment Elevation Myocardial Infarction and Left Ventricular Aneurysm

作　　者：陈洋 詹洮 颜治 罗传毅 王艳 CHEN Yang;ZHAN Tao;YAN Zhi;LUO Chuanyi(Department of Cardiology,Second People′s Hospital of Yibin City,Yibin,Sichuan 644000,China)

机构地区：[1]宜宾市第二人民医院心内科,四川宜宾644000 [2]不详

出　　处：《岭南心血管病杂志》2023年第4期358-363,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)伴左心室室壁瘤(left ventricular aneurysm,LVA)患者发病早期继发左心室血栓的危险因素。方法回顾性分析宜宾市第二人民医院2012年1月至2021年1月收治STEMI伴LVA患者共196例的临床资料,根据发病后2周内检出左心室血栓情况分组,即血栓组(70组)和非血栓组(126例),比较两组患者的基线特征资料及治疗情况,进一步评估发病早期继发左心室血栓的独立危险因素。结果血栓组患者年龄、血红蛋白(hemoglobin,HGB)浓度、既往心绞痛史比例、左心室射血分数(left ventricular ejection fraction,LVEF)水平、冠状动脉侧支循环形成比例及接受急诊介入治疗或药物溶栓比例均显著低于非血栓组,差异有统计学意义(P<0.05);血栓组患者<60岁比例、血肌酐(serum creatinine,SCr)浓度、慢性肾脏病(chronic kidney disease,CKD)患者比例、长期大量饮酒患者比例、贫血患者比例、LVEF≤40%患者比例、术前心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级0级患者比例及术后TIMI血流分级≤2级患者比例均显著高于非血栓组,差异有统计学意义(P<0.05)。多因素分析结果显示,贫血、LVEF≤40%及术前TIMI分级0级均是患者发病早期继发左心室血栓的独立危险因素(P<0.05);既往心绞痛史、冠状动脉侧支循环形成及接受急诊介入治疗或药物溶栓治疗均是患者发病早期继发左心室血栓的独立保护因素(P<0.05)。结论STEMI伴LVA患者发病早期继发左心室血栓发生与贫血、LVEF≤40%及术前TIMI分级0级关系密切,而既往心绞痛史、冠状动脉侧支循环形成,接受急诊介入治疗或药物溶栓治疗的患者出现左心室血栓风险往往较低。Objectives To investigate the risk factors of secondary left ventricular thrombosis in early stage of patients with ST-segment elevation myocardial infarction(STEMI)and left ventricular aneurysm(LVA).Methods Totally 196 characteristics of STEMI patients with LVA were retrospectively analyzed in the period from January 2012 to January 2021 in Second People′s Hospital of Yibin City.All the patients were grouped according to the detection of left ventricular thrombosis within 2 weeks after onset of STEMI with LVA,and divided into thrombosis group(n=70)and non thrombosis group(n=126).The baseline characteristics and treatment of the two groups were compared to further evaluate the indepen⁃dent risk factors of secondary left ventricular thrombosis in the early stage of onset.Results The age,concentration of hemoglobin(HGB),the proportion of patients with previous angina pectoris,left ventricular ejection fraction(LVEF),the establishment proportion of patients with coronary collateral circulation and emergency percutaneous coronary inter⁃vention(PCI)or drug thrombolysis in thrombosis group were significantly lower than those of non thrombosis group(P<0.05).The proportion of patients<60 years old,concentration of serum creatinine(SCR),proportions of patients with chronic kidney disease(CKD),alcoholism,anemia,LVEF≤40%,preoperative blood flow thrombolysis in myocardial infarction(TIMI)grade 0 and postoperative blood flow TIMI≤grade 2 in thrombosis group were significantly higher than those of non thrombosis group(P<0.05).Multivariate Logistic regression analysis showed that anemia,LVEF≤40%and preoperative blood flow TIMI grade 0 were independent risk factors for secondary left ventricular thrombosis in patients with acute STEMI with LVA(P<0.05).History of angina pectoris,establishment of coronary collateral circulation and emergency PCI or drug thrombolysis were independent protective factors for secondary left ventricular thrombosis in patients with acute STEMI with LVA(P<0.05).Conclusions The early secondary

关 键 词：心肌梗死 室壁瘤 血栓 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]