经皮冠状动脉介入术后心力衰竭的危险因素

Predictive factors for heart failure after percutaneous coronary intervention

目的探讨经皮冠状动脉介入术(PCI)治疗后住院期间发生心力衰竭的影响因素。方法回顾性选取2017年1月至2022年9月于杭州市第九人民医院行PCI治疗的534例冠心病患者,按照术后是否出现心力衰竭分成心力衰竭组51例与对照组483例,收集两组可能导致心力衰竭的因素进行单因素比较和多因素分析,并建立预测模型。结果单因素分析发现,PCI术后心力衰竭组与对照组入院时的年龄、合并脑梗死、合并高血压、纽约心脏病学会(NYHA)心功能分级、左室射血分数(LVEF)情况及白蛋白、衍生中性粒细胞/淋巴细胞(dNLR)、D-二聚体、N末端B型利钠肽原(NT-proBNP)水平比较,差异有统计学意义(均P<0.05)。多因素分析发现:年龄≥60岁、LVEF<40%、合并脑梗死、NYHA心功能分级Ⅱ/Ⅲ级、白蛋白<40.15 g/L、dNLR≥2.30为PCI术后住院期间发生心力衰竭的独立危险因素(均P<0.05)。结论年龄、LVEF、合并脑梗死、NYHA心功能分级、白蛋白以及dNLR均可对冠心病PCI治疗后住院期间心力衰竭的发生构成影响,基于上述指标建立的预测模型可为临床提供一定指导。

Objective To investigate the factors predictive of heart failure developing during hospital stay after undergoing percutaneous coronary intervention(PCI).Methods A retrospective analysis was performed on 534 patients with coronary heart disease who underwent PCI treatment at Hangzhou Ninth People′s Hospital from January 2017 to September 2022.The patients were divided into two groups according to whether heart failure occurred after the operation:a heart failure group consisting of 51 patients and a control group consisting of 483 patients.Univariate comparison and multivariate analysis were performed on factors that could lead to heart failure between the two groups,and a prediction model was established.Results Univariate analysis showed that there were significant differences in age at admission,presence of cerebral infarction,presence of hypertension,New York Heart Association(NYHA)heart function classification,left ventricular ejection fraction(LVEF),serum albumin,neutrophil-to-lymphocyte ratio(dNLR),D-dimer,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels between the PCI postoperative heart failure group and the control group(all P<0.05).Multivariate analysis showed that age≥60 years,LVEF<40%,presence of cerebral infarction,NYHA heart function classificationⅡ/Ⅲ,serum albumin<40.15 g/L,and dNLR≥2.30 were independent risk factors for the development of heart failure during hospitalization after PCI(all P<0.05).Conclusions Age,LVEF,presence of cerebral infarction,NYHA heart function classification,serum albumin,and dNLR can all affect the occurrence of heart failure during hospitalization after PCI for coronary heart disease.Establishing a prediction model based on these indicators can provide guidance for clinical practice.