急性心梗患者PCI术后血压昼夜节律与MACE的相关性  

Correlation between circadian rhythm of blood pressure after PCI and major adverse cardiovascular events in patients with acute myocardial infarction

作　　者：薛蒙 金元超 王琮翰 长孙彦玲 林奔腾 谢芳元[1] XUE Meng;JIN Yuan-chao;WANG Cong-han;ZHANGSUN Yan-ling;LIN Ben-teng;XIE Fang-yuan(Department of Cardiology,Xi’an People’s Hospital&Xi’an Fourth Hospital,Xi’an 710004,Shaanxi,China)

机构地区：[1]西安市人民医院、西安市第四医院心内科,陕西西安710004

出　　处：《心脏杂志》2023年第6期656-660,共5页Chinese Heart Journal

摘　　要：目的 探讨急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)治疗术后的血压昼夜节律与再发主要不良心血管事件(MACE)的相关性。方法 收集2019年6月~2020年12月西安市人民医院心内科STEMI患者的临床资料,共112例,根据PCI术后第一天夜间血压下降率(NBPDR)将患者分为杓型组、非杓型组、超杓型组、反杓型组,平均随访1.5年,运用单因素Kaplan-Meier回归和多因素COX回归模型比较四组的基线资料与再发MACE的相关性。结果 与杓型组相比,非杓型组(P<0.05)和反杓型组(P<0.01)发生MACE的风险较高。女性患者中非杓型组,>65岁患者中反杓型组和<65岁患者中超杓型组发生MACE的风险增加(P<0.05),而重度冠脉病变亚组中反杓型组发生MACE风险高(P<0.05)。RCS曲线显示当NBPDR=17.05%时再发MACE风险最低。结论 血压昼夜节律与STEMI患者PCI术后再发MACE的风险密切相关,NBPDR是STEMI患者PCI术后的独立危险因素。AIM To investigate the correlation between circadian rhythm of blood pressure after percutaneous coronary intervention(PCI) and major adverse cardiovascular events(MACE) in patients with ST segment elevation myocardial infarction(STEMI).METHODS Clinical data of STEMI patients in the Department of Cardiology,Xi'an People's Hospital were collected from June 2019 to December 2020,with a total of 112 cases.According to the nocturnal blood pressure drop rate(NBPDR)on the first day after PCI,the patients were divided into dipper group,non-dipper group,super-dipper group and reverse dipper group,and the patients were followed up for an average of 1.5 years.Univariate Kaplan-Meier regression and multivariate Cox regression models were used to compare the correlation between baseline data and MACE of the four groups.RESULTS Compared with the dipper group,the non-dipper group(P<0.05) and reverse-dipper group(P<0.01) had an increasing risk of MACE.Subgroup analysis showed that female patients in the non-dipper group,patients over 65 years old in the reverse-dipper group and patients younger than 65 years old in the super-dipper group had an increasing risk of MACE(P<0.05),while patients with severe coronary artery disease in the reverse-dipper group had a higher risk of MACE(P<0.05).Additionally,the RCS curve showed that MACE risk was the lowest when NBPDR was equal to 17.05%.CONCLUSION Blood pressure circadian rhythm is closely related to the recurrence of MACE in STEMI patients after PCI.

关 键 词：急性ST段抬高型心肌梗死 血压昼夜节律 夜间血压下降率 主要不良心血管事件 

分 类 号：R544[医药卫生—心血管疾病]