急性ST段抬高型心肌梗死直接PCI并发MACCE及大出血事件的相关因素

Correlation factors for major adverse cardiac and cerebrovascular events or hemorrhage in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention

目的:回顾性分析急性ST段抬高型心肌梗死(STEMI)患者住院行直接冠状动脉介入治疗术(PCI)后发生主要不良心脑血管事件(MACCE)及大出血的相关因素。方法:以2008年9月～2010年8月收住的235例STEMI在12 h内行直接PCI术的患者为研究对象,分为病例组(包括MACCE及大出血)和对照组。搜集手术、药物、实验室等相关因素,包括急性梗死相关血管、术中有无慢血流和无再流发生及处理、处理前后血流分级、急性梗死相关血管球囊预扩张及支架扩张最高压力等数据,同时搜集左室射血分值、血小板计数、嗜酸性粒细胞计数、嗜碱性粒细胞计数、凝血系列、肝肾功、血脂4项、空腹血糖及心肌标志物等检测指标。采用多因素Logistic回归的方法分析上述因素与MACCE及大出血的相关性。结果:单因素分析显示病例组在急性IRA行直接支架植入术的比率、凝血酶原时间、CK方面高于对照组(P<0.05),在年龄、急性IRA慢血流及无再流的发生率、术前术中IABP的使用率、Killip分级、并发CTO的血管数量、急性IRA预扩最高压力、FPG、Cr、CK-MB方面显著高于对照组(P<0.01);而病例组在冠脉内替罗非班使用率、行2次PCI的比率、急性IRA支架的最高压力方面低于对照组(P<0.05),在男性患者的比率、慢血流及无再流处理前和处理后TIMI分级、植入支架的总数量、UA、TC、LDL-C、HDL-C、左室射血分数值(LVEF)方面显著低于对照组(P<0.01)。多因素Logistic回归分析显示年龄、冠脉内注射替罗非班、LVEF值与MACCE及大出血具有相关性(P<0.05),慢血流及无再流处理后TIMI分级与MACCE及大出血具有显著相关性(P<0.01)、其中年龄呈正相关,冠脉内注射替罗非班、慢血流及无再流处理后TIMI分级及左室射血分值呈负相关。结论:高龄、慢血流及无再流处理后TIMI分级小和LVEF值低是MACCE及大出血的危险因素;冠脉内注射替罗非班是保护因素。

AIM： To analyze correlation factors for major adverse cardiac and cerebrovascular events （MACCE） or hemorrhage in patients with acute ST-elevation myocardial infarction （STEMI） after primary percutaneous coronary intervention （PCI）. METHODS： Two hundred and twenty-five cases of patients with STEMI in our department from September, 2008 to August 2010 were analyzed retrospectively.Patients with STEMI after PCI were divided into two groups： MACCE-hemorrhage group and non-MACCE or hemorrhage group, and the relationship between factors and MACCE-hemorrhage were analyzed by multivariate logistic regression. RESULTS： Patients in the MACCE-hemorrhage group had a higher proportion of direct stenting techniques and occurrence of slow or no-reflow and using intra-aortic balloon pump （IABP）, number of all vessels with chronic total occlusion （CTO）, maximum pre-expansion pres- sure, PT, CK, and age than in the non-MACCE or hemorrhage group （P 〈0. 05 and P 〈0. 01 ）. However, patients in the MACCE-hemorrhage group had a lower proportion of tirofiban use, male patients, maximum pressure of stent expansion, TIMI class after slow or no-reflow treatment, number of all stents implanted, UA, TC, LDL-C, HDL-C, and LVEF than in the non-MACCE or hemorrhage group （P 〈 0.05 and P 〈 0. 0! ）. Multivariate logistic regression analysis showed that age, intracoronary use of tirofiban, and LVEF were correlative factors for MACCE-hemorrhage （ P 〈 0. 05 ）, and TIMI class after slow or no- reflow treatment was evidently a correlative factor for MACCE-hemorrhage （ P 〈 0. 01 ）. CONCLUSION ： Older age, lower TIMI class after slow or no-reflow treatment and low LVEF are risk factors for MACCE- hemorrhage. Intracoronary use of tirofiban is a protective factor for MACCE-hemorrhage.