急性心肌梗死患者PCI术后ST段回落不良的影响因素及其预后

Influencing factors and prognosis of ST segment non-resolution after primary PCI in patients with acute myocardial infarction

目的:分析研究急性心肌梗死患者直接经皮冠状动脉介入(PCI)术后ST段回落不良(STNR)的影响因素及其预后。方法:选择225例急性ST段抬高型心肌梗死患者,直接进行PCI术治疗,按性别、伴发病、术前TI-MI分级、吸烟指数、症状发作-球囊扩张时间(SOTB)和术后不良事件计算STNR发生率。结果:225例患者共有69例(30.67%)发生STNR;伴发糖尿病(46.9%vs.28.0%)、高血压(48.7%vs.26.9%)、术前TIMI分级0～2级(34.1%vs.20.7%)、吸烟指数≥400(46.2%vs.24.4%)、SOTB>3h(46.5%vs.26.9%)者ST-NR发生率明显升高(P均<0.05),且存在术后不良事件(心绞痛、心律失常、再次心梗、心源性死亡)者STNR发生率明显高于其对应患者(10.1%比1.3%、8.7%比0.64%、4.3%比0、2.9%比0),P均<0.05。结论:有伴发病、术前TIMI 0～2级、吸烟指数≥400及SOTB>3h均是急性心肌梗死患者直接PCI术后ST段回落不良的重要影响因素,且ST段回落不良患者预后不佳。

Objective：To study and analyze the influencing factors and prognosis of ST-segment non-resolution（STNR）after primary percutaneous coronary intervention（PCI）in patients with acute myocardial infarction（AMI）.Methods：A total of 225patients with acute ST-segment elevation myocardial infarction（STEMI）were enrolled.All patients received primary PCI.Incidence rates of STNR were counted according to patients′genders,basic diseases,thrombolysis in myocardial infarction（TIMI）grade before PCI,smoking index,symptom-onsetto-balloon-dilatation duration（SOTB）and adverse events after PCI.Results：STNR occurred in 69cases（30.67%）among the 225patients;The STNR incidence rate significantly increase in patients with diabetes mellitus（46.9% vs.28.0%）,hypertension（48.7% vs.26.9%）,TIMI grade 0～2before PCI（34.1% vs.20.7%）,smoking index≥400（46.2% vs.24.4%）,SOTB 〉3h（46.5% vs.26.9%）,and with adverse events after PCI [angina pectoris（10.1% vs.1.3%）,arrhythmia（8.7% vs.0.64%）,myocardial re-infarction（4.3% vs.0）,cardiogenic death（2.9% vs.0）]in patients with STNR compared with corresponding patients,P〈0.05all.Conclusion：Complicated diseases,TIMI grade 0～2before operation,smoking index≥400and SOTB 〉3hare important influencing factors of STNR after primary PCI in AMI patients,and prognosis is poor in patients with STNR.