ST段抬高型心肌梗死患者发生冠状动脉无复流后远期主要不良心血管事件的研究  

The long-term major adverse cardiovascular events in patients with ST segment elevation myocardial infarction after no reflow of coronary artery

作　　者：余英[1] 马立萍[1] 高绪霞[1] YU Ying;MA Liping;GAO Xuxia(Department of General Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所全科医疗科,100029

出　　处：《心肺血管病杂志》2024年第11期1127-1133,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项(首发2022-2-20610);首都全科医学研究专项(21QK19)。

摘　　要：目的:冠状动脉无复流是ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者接受PCI术后的严重并发症,与术后重大心血管不良事件(major adverse cardiovascular events,MACE)关系密切。本研究收集了STEMI并行直接PCI治疗患者的相关资料,进行10年远期随访,研究发生无复流的患者相关临床特征和远期MACE。方法:回顾性分析了2010年1月至2013年1月期间,胸痛发作12h以内在北京安贞医院就诊的914例患者的临床资料,均确诊为STEMI,并接受了直接PCI治疗且在心脏内科住院治疗完善相关检查。其中不符合标准的患者40例,最终纳入分析人数为874例患者,并进行10年远期随访,收集患者远期MACE数据。根据是否为发生无复流,分为无复流组(183例)和正常复流组(691例),分析两组患者基础临床资料、实验室指标、冠状动脉造影各项指标、远期MACE的差异。结果:基本资料显示,无复流组合并2型糖尿病比例[63(34.4%)vs.171(24.7%),P=0.009]、心率[(82±18)vs.(76±14)次/min,P<0.001]、Killip分级>Ⅰ[148(80.9%)vs.507(73.4%),P=0.037]、EF<35%[26(14.2%)vs.35(5.1%),P<0.001]、室壁瘤[15(8.2%)vs.30(4.3%),P=0.036]明显高于正常复流组,WBC[(12.2±3.5)vs.(10.6±3.2)×10^(9)/L,P<0.001]、中性粒细胞计数[(10.0±3.3)vs.(8.1±3.2)×10^(9)/L,P<0.001]、随机血糖[(10.1±5.5)vs.(8.1±4.9)mmol/L,P<0.001]、hs-CRP[9.5(3.8,18.6)vs.7.1(2.9,13.6)mg/L,P=0.002]、LDL-C[(3.2±0.8)vs.(3.1±0.7)mmol/L,P=0.019]水平明显高于正常复流组,淋巴细胞计数[1.4(1.0,1.9)vs.1.6(1.2,2.2)×10^(9)/L,P=0.027]低于正常复流组;冠状动脉造影指标显示,无复流组多支病变发生比例[99(49.2%)vs.150(21.7%),P<0.001]明显高于正常复流组,术中糖蛋白Ⅱb/Ⅲa抑制剂使用[137(74.9%)vs.138(20.0%),P<0.001]、主动脉内球囊反搏术使用[44(24.0%)vs.43(6.2%),P<0.001]、血栓抽吸术[143(78.1%)vs.329(47.6%),P<0.001]明显多于正常复流组;10年远期随访显示无复流组发生心血管累计�Objective:No reflow of coronary is a serious complication after PCI in patients with ST segment elevation myocardial infarction(STEMI),and is closely related to major adverse cardiovascular events(MACE).This study collected relevant data on STEMI patients treated with direct PCI and conducted a 10-year long-term follow-up,to study the clinical characteristics and long-term MACE of patients with no reflow.Methods:A retrospective analysis was conducted on 914 patients who underwent chest pain within 12 hours of onset at Beijing Anzhen Hospital from January 2010 to January 2013.All patients were diagnosed with STEMI and received direct PCI treatment,and were hospitalized in the cardiology department to complete relevant examinations.Among them,40 patients did not meet the standards,and the final number of patients included in the analysis was 874.Relevant medical data of the above patients were collected and followed up for 10 years to collect long-term MACE data.According to whether there is no reflow,the two groups were divided into a non reflow group(183 cases)and a normal reflow group(691 cases).The differences in basic clinical data,laboratory indicators,coronary angiography indicators,and long-term MACE between the two groups were analyzed.Results:The basic data showed that the proportion of no reflow group combination with type 2 diabetes[63(34.4%)vs.171(24.7%),P=0.009],heart rate[(82±18)vs.(76±14)times/min,P<0.001],Killip grade>Ⅰ[148(80.9%)vs.507(73.4%),P=0.037],EF<35%[26(14.2%)vs.35(5.1%),P<0.001],ventricular aneurysm[15(8.2%)vs.30(4.3%),P=0.036]were significantly higher than that of normal reflow group,and the total number of white blood cells[(12.2±3.5)vs.(10.6±3.2)×10^(9)/L,P<0.001],neutrophil count[(10.0±3.3)vs.(8.1±3.2)×10^(9)/L,P<0.001],random blood glucose[(10.1±5.5)vs.(8.1±4.9)mmol/L,P<0.001],hs-CRP[9.5(3.8,18.6)vs.7.1(2.9,13.6)mg/L,P=0.002],LDL-C[(3.2±0.8)vs.(3.1±0.7)mmol/L,P=0.019]levels were significantly higher than those in the normal reflow group,and lymphocyte count[1.4(1.0,1.9)

关 键 词：ST段抬高型心肌梗死 无复流 主要不良心血管事件 

分 类 号：R54[医药卫生—心血管疾病]