急性心肌梗死药物涂层球囊扩张术后2年主要不良心血管事件的危险与保护因素分析  

Analysis of Risk and Protective Factors for Major Adverse Cardiovascular Events 2 Years After Drug-Coated Balloon Angioplasty in Acute Myocardial Infarction Patients

作　　者：张登庆 蔡文玉[1] 叶胜义 陈子敏 ZHANG Dengqin;CAI Wenyu;YE Shengyi;CHEN Zimin(Jinjiang HospitalInternal Medicine-Cardiovascular Department(Shanghai Sixth People's Hospital Fujian Hospital),Jinjiang 352200,China)

机构地区：[1]晋江市医院心血管内科(上海市第六人民医院福建医院),福建晋江352200

出　　处：《中华灾害救援医学》2025年第1期40-44,共5页Chinese Journal of Disaster Medicine

基　　金：泉州市科技计划项目(2022N027S)。

摘　　要：目的 探索急性心肌梗死药物涂层球囊扩张术后2年发生主要不良心血管事件(Major Adverse CardiacEvents,MACE)的危险因素与保护因素。方法 回顾性分析2023年1月至2024年8月晋江市医院心血管内科收治的78例急性心肌梗死患者相关临床资料,包括研究对象的基础资料、疾病史、实验室检查指标、病变血管位置、冠状动脉改变情况、预扩张球囊类型、药物涂层球囊、术后情况。根据患者药物涂层球囊扩张术后2年MACE的发生情况,将研究对象分为非MACE组(54例)和MACE组(24例)。对两组患者上述资料进行Logistic回归分析,探索急性心肌梗死药物涂层球囊扩张术后2年发生MACE的相关因素,并对其保护因素进行分析。结果 单因素分析结果显示非MACE组患者血管内超声(Intravascular Unltrasound,IVUS)指导比例、脂蛋白a[Lipoprotein a,Lp(a)]水平、冠状动脉中重度钙化比例均低于MACE组患者;病变血管为左回旋支(LCX)比例和病变血管为分支血管比例高于MACE组(P<0.05)。多因素Logistic回归分析结果显示Lp(a)水平、病变血管为LCX、病变血管为分支血管、冠状动脉血管病变≥2支、冠状动脉中重度钙化为急性心肌梗死药物涂层球囊扩张术后2年发生MACE的独立影像因素。结论 Lp(a)水平高、冠状动脉血管病变≥2支、冠状动脉中重度钙化为急性心肌梗死药物涂层球囊扩张术后2年发生MACE的独立危险因素,而病变血管为LCX和分支血管为术后2年发生MACE的独立保护因素。Objective To explore the risk and protective factors associated with major adverse cardiac events(MACE)occurring 2 years after drug-coated balloon(DCB)angioplasty in patients with acute myocardial infarction(AMI).Methods A retrospective analysis was conducted on the clinical data of 78 AMI patients admitted to the Cardiovascular Department of Jinjiang Hospital from January 2023 to August 2024.The data included baseline characteristics,medical history,laboratory test results,lesion vessel location,coronary artery changes,pre-dilatation balloon type,drug-coated balloon usage,and post-procedural outcomes.Based on the occurrence of MACE within 2 years following DCB angioplasty,the patients were divided into two groups:the non-MACE group(54 patients)and the MACE group(24 patients).Logistic regression analysis was performed to identify the factors associated with the occurrence of MACE and to explore potential protective factors.Results Univariate analysis showed that the non-MACE group had lower proportions of intravascular ultrasound(IVUS)guidance,lipoprotein(a)[Lp(a)]levels,and severe coronary artery calcification compared to the MACE group.The proportion of lesions located in the left circumflex artery(LCX)and branch vessels was higher in the non-MACE group than in the MACE group,with statistically significant differences(P<0.05).Multivariate logistic regression analysis revealed that elevated Lp(a)levels,lesions in the LCX, lesions in branch vessels, coronary artery disease involving ≥ 2 vessels, and severe coronary artery calcification were independent risk factors for MACE occurring 2 years after DCB angioplasty in AMI patients. Conclusion High Lp(a) levels, coronary artery disease involving ≥ 2 vessels, and severe coronary artery calcification are independent risk factors for MACE occurring 2 years after drug-coated balloon angioplasty in patients with acute myocardial infarction. In contrast, lesions in the LCX and branch vessels serve as independent protective factors against MACE during this period .

关 键 词：急性心肌梗死 药物涂层球囊扩张术 心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]