多种无创指标在介入术后心肌梗死患者预后中的价值研究

Value of Non-invasive Indicators in Predicting the Cardial Events in Acute Myocardial Infarction Patients with Coronary Intervention

目的探讨多种无创性指标联合临床危险因素在接受经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的急性心肌梗死(acute myocardial infarction,AMI)患者预后中的价值。方法前瞻性搜集2010年1月～2011年6月期间笔者医院接受PCI治疗的104例AMI患者的资料,所有患者起病3个月内序贯接受无创性检查(包括常规心电图、动态心电图、活动平板负荷试验、超声心动图)。平均随访1年,根据随访期间患者有无发生主要心脏事件(心源性死亡、充血性心力衰竭、再发心肌梗死、恶性心律失常)分为有事件组和无事件组,纳入常见的临床危险因素后,对上述数据分别进行Logistic多因素回归分析。结果按是否发生各主要心脏事件分别行单因素分析,筛选出差异有明显统计学意义(P<0.01)的指标。将各指标纳入多因素Logistic回归分析发现TS、LVEF、Tp-Te间期与AMI患者PCI术后近期发生主要心脏事件密切相关。结论 TS、LVEF、Tp-Te间期是AMI患者PCI术后近期发生主要心脏事件的独立危险因素,其中TS(OR=5.470,P=0.023)是预测心源性死亡最强的变量,LVEF(OR=4.348,P=0.042)、(OR=3.245,P=0.017)是预测充血性心力衰竭、再发心肌梗死最强的变量,Tp-Te间期(OR=6.372,P=0.037)是预测恶性心律失常最强的变量。

Objective To explore the value of non - invasive indicators combined with clinical risk factors in predicting the cardial events in acute myocardial infarction （AMI） patients with percutaneous coronary intervention（PC1）. Methods The clinical data of the 104 patients with AMI who accepted PCI in our hospital during January 2010 -June 2011 period were collected prospectively. All the pa- tients received ECG, Holter, treadmill exercise test, echocardiography since the onset of 3 months. After one year follow - up,all the pa- tients were divided into event group and no- event group according to the major adverse cardiac events（include cardiac death,congestive heart failure,recurrent myocardial infarction,malignant arrhythmia variable） or not. After incorporating the common clinical risk factors, the data were analyzed by logistic regression analysis. Results Indicators having statistically significant difference （ P 〈 0.01 ） were screened out with single factor analysis in each event sub - group according to whether there was the occurrence of major cardiac events, thereafter independent risk factors were determined with multivariate logistic regression analysis. Multivariate Logistic regression analysis found that TS, LVEF and Tp - Te interval were significant correlation with the rate of recent major adverse cardiac events in AMI patients after PCI. Conclusion The AMI patients after PCI with low turbulence slope（ TS）, LVEF and long Tp -Te interval were the independent risk factor affecting its recent major cardiac events. In the three factors ,TS（ OR = 5. 470 ,P = 0. 023 ） was the strongest variable of predicting cardiac death, LVEF（ OR = 4. 348,P = 0. 042）, （ OR = 3. 245,P = 0. 017） was the strongest variable of predicting congestive heart failure and recurrent myocardial infarction, Tp - Te interval （ OR = 6. 372, P = 0. 037 ） was the strongest prediction of malignant arrhythmia variable.