ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后远期主要不良心血管事件的危险因素及风险评分系统预测价值研究  

Risk Factors and Predictive Value of Risk Scoring Systems for Long-term Major Adverse Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction Following Percutaneous Coronary Intervention

作　　者：张国莉 赵荣荣[2] 彭国恬 孙瑞仪 乔鹏宇 燕芳红 韩琳[1,3,4] ZHANG Guoli;ZHAO Rongrong;PENG Guotian;SUN Ruiyi;QIAO Pengyu;YAN Fanghong;HAN Lin(Evidence-based Nursing Center,School of Nursing,Lanzhou University,Lanzhou 730000,China;Department of Cardiology,the First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China;The First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China;Nursing Department,Gansu Provincial Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学循证护理中心兰州大学护理学院,甘肃省兰州市730000 [2]兰州大学第一医院心内科,甘肃省兰州市730000 [3]兰州大学第一临床医学院,甘肃省兰州市730000 [4]甘肃省人民医院护理部,甘肃省兰州市730000

出　　处：《中国全科医学》2024年第15期1802-1810,共9页Chinese General Practice

基　　金：国家自然科学基金资助项目(72274087);国家社会科学基金资助项目(20CGL053);兰州大学中央高校基本科研业务项目(lzujbky-2023-28);甘肃省人民医院优秀硕/博士生培育计划(22GSSYD-6);2020 China Medical Board Open Competition Program(#20-374)。

摘　　要：背景ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后远期发生主要不良心血管事件(MACEs)的风险大,指南指出准确的早期危险分层对STEMI患者PCI术后MACEs的管理具有重要意义。目前,常用的风险评分系统包括年龄、血肌酐和射血分数(ACEF)评分、心肌梗死溶栓(TIMI)评分、Zwolle评分、首次心肌梗死血管成形术(PAMI)评分、使用控制阿昔单抗和装置的研究以降低晚期血管成形术并发症(CADILLAC),然而哪种风险评分系统更适用于预测STEMI患者PCI治疗远期预后尚无定论。目的分析我国STEMI患者PCI术后远期MACEs发生的危险因素并比较我国目前常用的ACEF、TIMI、Zwolle、PAMI、CADILLAC五种风险评分系统对其远期MACEs发生风险的预测价值。方法回顾性选取2016年6月—2020年6月在甘肃省人民医院心内科成功完成首次PCI术的687例STEMI患者为研究对象。收集患者一般资料与实验室及影像学检查结果,患者入组后均采用ACEF、TIMI、Zwolle、PAMI、CADILLAC风险评分系统进行评分。出院后通过电话及门诊复查方式随访患者,每年随访1次,随访时间截至2023年8月,主要记录随访期间患者MACEs的发生情况。采用多因素Logistic回归分析探究STEMI患者PCI术后远期MACEs发生的影响因素。绘制不同风险评分系统诊断MACEs的受试者工作特征曲线(ROC曲线),采用DeLong检验比较各风险评分系统的ROC曲线下面积(AUC)。结果687例STEMI患者接受了PCI术,随访过程中44例患者因基本资料数据缺失过多被剔除,最终纳入643例患者,中位随访时间为37(25,49)个月。至随访结束共有134例发生MACEs,发生率为20.8%。MACEs组和非MACEs组年龄、住院时间、Killip分级、脑利钠肽前体、纤维蛋白原、贫血、左心室射血分数、估算肾小球滤过率、血肌酐、瓣膜返流比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:住院时间延长(OR=Background Patients with ST-segment elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI)face a significant risk of long-term major adverse cardiovascular events(MACEs).Accurate early risk stratification is crucial for managing post-PCI MACEs in STEMI patients,as highlighted in clinical guidelines.Existing risk scoring systems,including the Age,Creatinine,and Ejection Fraction(ACEF)score,Thrombolysis in Myocardial Infarction(TIMI)score,Zwolle score,Primary Angioplasty in Myocardial Infarction(PAMI)score,and Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications(CADILLAC)score,vary in their predictive utility for the long-term prognosis post-PCI in STEMI patients.Objective This study aims to analyze the risk factors for long-term MACEs post-PCI in STEMI patients in China and compare the predictive value of the commonly used ACEF,TIMI,Zwolle,PAMI,and CADILLAC risk scoring systems.Methods A retrospective cohort of 687 STEMI patients who underwent their first PCI between June 2016 and June 2020 at Gansu Provincial Hospital was selected.Patient demographics,laboratory,and imaging results were collected,and risk scores were assigned using the ACEF,TIMI,Zwolle,PAMI,and CADILLAC systems.Patients were followed up annually via phone or clinic visits until August 2023,with a focus on the occurrence of MACEs.Multivariable Logistic regression analysis was used to explore the factors influencing the occurrence of MACEs post-PCI.Receiver operating characteristic(ROC)curves for the different risk scoring systems were plotted,and their areas under the curve(AUC)were compared using the DeLong test.Results Out of the 687 patients who underwent PCI,44 were excluded due to incomplete data,leaving 643 for analysis.The median follow-up period was 37(range 25-49)months.By the end of the follow-up,134 patients had experienced MACEs,representing a 20.8%incidence rate.The MACEs group differed significantly from the non-MACEs group in terms of age,hospital stay duration,Killi

关 键 词：ST段抬高型心肌梗死 经皮冠状动脉介入治疗 主要不良心血管事件 影响因素 风险评分 

分 类 号：R542.22[医药卫生—心血管疾病]