经皮冠状动脉介入治疗患者围手术期TnI升高的相关因素分析

Study on factors related to troponin I elevation after percutaneous coronary intervention

目的:研究经皮冠状动脉(冠脉)介入治疗(percutaneous coronary intervention,PCI)患者围手术期肌钙蛋白I(Troponin I,TnI)升高的相关因素。方法:共入选235例术前TnI正常的择期PCI患者,根据其术后第1天晨血TnI水平分为术后TnI值正常组、术后TnI超过正常值上限但小于5倍组和术后TnI超过正常值上限5倍组共3组。对各组的基线资料、冠脉病变特点等进行比较,利用Logistic回归分析PCI围手术期TnI升高的重要预测因素。结果:235例择期PCI患者中,术后TnI超过正常值上限5倍组患者占34.9%,TnI超过正常值上限但小于5倍组占31.1%,3组患者间的冠脉病变特点存在统计学差异(P<0.05)。Logistic回归分析显示,年龄、多枚支架植入和病变类型(B/C型)是PCI围手术期相关心肌损伤的重要预测因素。结论:年龄、多枚支架植入和复杂病变类型是预测PCI围手术期心肌损伤发生的因素。

Objective To examine the factors related to elevation of troponin Ⅰ （TnI） after percutaneous coronary intervention （PCI）. Methods A total of 235 patients with normal preoperative myocardial protein undergoing elective PCI was enrolled. Based on the TnI level on the morning of first postoperative day, the patients were divided into three different groups： TnI normal group（≤0.04 ng/mL, group Ⅰ ）, TnI exceeding the upper limit of normal but less than five times （〉0.04 ng/ mL and ≤0.20 ng/mL group Ⅱ ） , and TnI more than five times the upper limit of normal （〉0,20 ng/mL, group Ⅲ）. The baseline data and characteristics of coronary lesion of these three groups were compared. Logistic regression analysis was used to detect the predictors of procedural myocardial injury. Results Group Ⅰ occupied 34.9% and group Ⅱ comprised 31.1% of the patients. There were significant differences in characteristics of coronary lesion between these three groups. Logistic regression analysis showed that age, multiple stent implantation and lesion type （B/C type） were the important predictors for PCI-related perioperative myocardial injury （OR 1.036, 2.011, 3.687; 95% confidence interval 1.005-1.068, 1.248-3.240, 1.871-7.268; P〈0.05）. Conclusions Age, multiple stent implantation and complex type lesion are predictors of perioperative myocardial injury in elective PCI.