急性前壁心肌梗死介入治疗后左心室重构状况及相关危险因素分析

Status of left ventricular remodeling and the related risk factors in patients with acute anterior myocardial infarction after PCI

目的:探讨急性前壁心肌梗死患者通过经皮冠状动脉介入治疗术(PCI),开通梗死相关血管(IRA)后左心室重构状况及心脏扩大的相关危险因素。方法:连续入选符合本研究入选标准的406例急性前壁心肌梗死患者,采集住院期间临床资料,查阅出院后门诊电子病历,记录用药情况、化验、检查结果。回顾性分析患者出院6个月后左心室重构状况,Logistic多元回归分析心脏扩大的相关危险因素。结果:354例患者完成随访,随访率87.2%,平均随访时间6.2个月。247例患者接受早期再灌注治疗。出院6个月后103例患者发生心脏扩大。心脏扩大的独立危险因素包括:住院期间心脏扩大、心电图Q波导联数及UCG室壁运动异常节段数目较多,住院期间心功能较差(killip分级),ACEI/ARB终剂量低于指南建议起始剂量的2倍。结论:尽管实施了有效PCI治疗,仍有部分患者发生心脏扩大,理想药物治疗应引起重视,尤其对于高危患者。

Objective：To investigate the status of left ventricular remodeling and the related risk factors of cardiac enlargement in patients with acute anterior myocardial infarction （MI） after infarct related artery （IRA） were opened by percutanous coronary intervention（PCI）. Methods ：406 consecutive patients with acute anterior MI who fulfilled the selecting criterion of this study were enrolled. In hospital clinical data were collect- ed and the out-patient electronic medical records were reviewed. The status of medical therapy, results of exper- iment examination, and results of echocardiography were analyzed retrospectively. Logistic regression analysis was used to determine the related risk factors of cardiac enlargement. Results ： The follow-up were completed in 354 （87. 2% ） patients, average follow-up time was 6. 2 months. Early reperfusion were achieved in 247 pa- tients. The left ventricular end-diastolic diameter（LVEDD） enlarged in 103 patients. Independent risk factors for cardiac enlargement included： cardiac enlargement at baseline, more lead of ECG had Q wave, more seg- ments had abnormal wall motion, higher killip class when in hospital, and the final dose of ACEI/ARB less then two times of initial dose suggested by guidelines. Conclusion： Left ventricular remodeling progressed de- spite PCI, Optimal medical therapy desire the attention of clinician, especially in patients with more risk fac- tors.