急性心肌梗死患者经皮冠状动脉介入治疗术后早期再发心肌梗死的预测及分析

Predictors of early reinfarction in geriatric patients undergoing primary angioplasty for acute myocardial infarction

目的分析老年急性心肌梗死患者PCI术后早期再发心肌梗死的预测危险因素。方法连续选取行PCI术的老年急性心肌梗死患者共2 252例,将未发生心肌再梗死的患者2 176例作为无再梗死组,发生早期再发心肌梗死患者76例作为再梗死组,对再发心肌梗死的危险因素进行分析。结果 PCI术后早期再发心肌梗死发生率为3.4%,且以男性为主。与无再梗死组比较,再梗死组糖尿病患病率和入院时血糖水平较高,心功能较差、血管狭窄程度较重,PCI术前、术后TIMI血流分级较差,术后血栓形成和夹层发生率较高,差异有统计学意义(P<0.05,P<0.01)。多因素回归分析显示,老年、血糖增高、糖尿病、心功能(Killip分级)、多支血管病变和PCI术后血栓及夹层形成与早期再发心肌梗死密切相关。结论高龄、血糖增高、糖尿病、心功能、多支血管病变和PCI术后血栓及夹层形成是早期再梗死的高危因素。针对合并这些因素的高危患者应进行积极有效防治。

Objective To identify the incidence and predictors of early reiniarction（RE-MI） in geriatric patients undergoing primary PCI for acute myocardial infarction（AMI）. Methods A total of 2 252 patients with ST-segment elevation myocardial infarction treated with primary PCI between 2003 to 2008 were selected. Early reinfarction was defined when following clinical criteria were satisfied within 30 days after the procedure： （1）recurrent ischemic symptoms for ≥30 minutes after resolution of symptoms from initial MI; （2）new ST-T-wave changes or new Q waves; （3）reelevation of creatine kinase（CK） or CK-MB to higher levels than normal（or by another 20% if already higher than normal）. Results Early reinfarction was observed in 76（3.4%） geriatric patients. Multivariate regression analysis showed that senility, hyperglycemia, diabetes, advanced Killip class, multivessel disease, and presence of coronary dissection and thrombosis were inde- pendent predictors of 30-day reinfarction. Conclusions Among geriatric AMI patients undergoing primary angioplasty, above factors were independently associated with 30-day reinfarction. Optimal revascularization during primary PCI may decrease RE-MI rate.