摘要
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.
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2009年第4期254-256,共3页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
心肌梗塞
血管成形术
经腔
经皮冠状动脉
危险因素
预测
myocardial infarction
angioplasty, transluminal, percutaneous coronary
risk factors
forecasting