入院即刻肌酐水平对急性心梗患者经皮冠状动脉介入治疗预后的影响

Relationship Between Immediate Admission Creatinine Level and the Prognosis of Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

目的:探讨入院即刻肌酐水平对急性心梗患者经皮冠状动脉介入(PCI)治疗预后的影响。方法:对395例急性心梗并于12h内行PCI治疗患者按照入院即刻肌酐水平分为血肌酐升高组和正常组,比较两组患者短期观察和长期随访结局,并对长期随访不良结局的影响因素进行Logistic回归分析。结果:两组患者住院时间差异无统计学意义(P>0.05),血肌酐升高组死亡人数和肌酐值均高于正常组(P<0.05),主要心脏不良事件(MACE)发生率血肌酐升高组高于正常组但两者差异并无统计学意义(P>0.05);术后随访,两组患者死亡人数、MACE发生率和随访期终点肌酐水平差异均具有统计学意义(P<0.05);将患者死亡和出现MACE作为不良结局分析发现,年龄、糖尿病史、高血压史、陈旧性心梗史、Killip p≥2、血管病变程度≥2、eGFR和入院即刻肌酐水平均为不良结局的影响因素(P<0.05);对影响患者结局的各因素进行逐步Logistic回归分析发现,年龄、陈旧性心梗史、入院即刻肌酐水平和肾小球滤过率为急性心梗患者PCI治疗后出现不良结局的独立危险因素(P<0.05)。结论:入院即刻肌酐水平与患者长期预后关系更为密切,高肌酐水平者预后不良可能性更大。

Objective：To investigate the prognostic value of immediate admission creatinine assay in acute myocardial infarction（AMI）cases undergoing percutaneous coronary intervention（PCI）.Methods：A total of 395 AMI cases undergoing PCI within 12 hrs were involved into this study and divided into high creatinine level group and normal creatinine group according to the serum creatinine levels immediately assayed after hospital admission.The outcomes were recorded and compared between the two groups.Results：The hospitalized time and incidence of major adverse cardiac event（MACE）between the two groups showed no significant difference（P〉0.05）,but more death cases were found in high creatinine group in hospital（P〈0.05）.During three years＇ follow-up,the difference of death rate,incidence of MACE,and the level of creatinine at end were statistically significant between the two groups（P〈0.05）.Stepwise logistic regression analysis showed the indicators for death and MACE were old age,history of diabetes,history of hypertension,history of old myocardial infarction,Killip p≥2,increased glomerular filtration rate,vascular lesions≥2,and higher immediate admission creatinine levels（P〈0.05）.Conclusion：There is a close relationship between immediate admission creatinine levels and long term prognosis,and high creatinine level is a poor prognostic indicator for AMI patients undergoing PCI.