主动脉内球囊反搏术辅助治疗急性心肌梗死的生存率研究

Survival Rate of Acute Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention and Intra-aortic Balloon Pump

目的评估主动脉内球囊反搏术(IABP)治疗急性心肌梗死患者30 d和远期生存率,并确定30 d和远期全因死亡率的预测因子。方法回顾性队列研究,连续收集本中心2009年1月至2011年9月间57例应用IABP治疗急性心肌梗死患者的临床资料。用COX风险比例模型确定30 d和远期全因死亡率的预测因子。结果 57例患者中,男性占67.2%,平均年龄(62.75±11.96)岁,心源性休克占34.5%,既往有急性心肌梗死病史占64.9%,既往行经皮冠状动脉治疗占28.1%。IABP平均持续时间为(3.5±1.9)d。平均随访时间为20个月(范围1个月到2.5年)。患者中1 d,7 d,30 d后和180 d后的生存率分别为93%、82.5%、70.2%和63.2%。远期高死亡率的独立危险因子为机械通气,远期低死亡率的独立因子为补救性经皮冠状动脉介入治疗。结论 IABP治疗急性心肌梗死的30 d死亡率仍然很高,但远期生存率却可以接受。

Objective To evaluate a 30-day and long-term outcome of acute myocardial infarction patients treated with intra-aortic balloon pump, and to identify risk factors of a 30-day and long-term all-cause mortality. Methods A retrospective cohort study was performed by collecting detailed clinical and device data in our heart center, 57 consecutive acute myocardial infarction patients treated with IABP between January 2009 and September 2011 were included. A Cox proportional hazards model was used to identify the risk factors of a 30-day and long-term all-cause mortality. Resallts Among the 57 patients included in this cohort,38 （67.2%） were male and the mean age was 62.75± 11.96 years,20（ 34.5% ） had cardiogenic shock, 37 （64.9%） had acute myocardial infarction, 16（28.1% ） had previous PCI. The mean du- ration of IABP was 3.5± 1.9 days. Median follow-up was 20 months （range, 1 month to 2.5 years）. In patients who survived until IABP weaned, cumulative 1-, 7-, 30- and 180-day survival was 93%, 82.5%, 70.2%, and 63.2%, respectively. Independent risk factors of higher long-term mortality were mechanical ventilation. Independent risk factors of lower long-term mortality were rescue PCI. Conclusion M- though the 30-day mortality rate in acute myocardial infarction patients treat with IABP is higher, the long-term survival is acceptable.