急性心肌梗死后心力衰竭患者临床特征及预后分析

The prognosis and clinical characteristics of patients with heart failure after aucte myocardial infarction

目的探讨急性ST段抬高性心肌梗死后发生心力衰竭的危险因素。方法入选急性ST段抬高性心肌梗死患者,根据心功能情况分为心功能正常组及心功能减低组。比较两组患者临床资料、冠脉危险因素、冠脉造影结果和直接PCI结果,采用logistic回归分析影响住院期间死亡的危险因素。结果心肌梗死后发生心功能衰竭者发病年龄大,女性比例高,有陈旧性心肌梗死病史者比例高。心功能减低组接受主动脉内球囊反搏泵(intra-aortic balloonpump,IABP)植入治疗者比例高。多因素回归分析结果提示,肾功能不全和心功能降低是导致住院期间死亡的独立预测因素。结论急性心肌梗死合并心血管高危因素越多,年龄大,且未能接受介入检查和治疗患者易发生心功能衰竭。肾功能不全、心功能降低的急性ST段抬高性心肌梗死患者住院期间死亡风险明显升高。

Objective To compare the clinical background characteristics and factors affecting the prognosis of patients with acute ST segment elevation myocardial infarction（STEMI） between cardiac function grade Killip 1 and Killip2~4. Methods Patients with STEMI were enrolled, and were divided into normal cardiac function group（Killip 1） and reduced cardiac function group（Killip 2~4）. The clinical background data, coronary risk factors, coronary angiographic results, direct PCI results were compared between the two groups, and the risk factors for death during hospitalization were also evaluated. Results In the reduced cardiac function group, patients were more advanced in age, higher proportion of female gender, more patients with history of myocardial infarction compared with patients in normal cardiac function group. In addition, the peak blood level of creatine kinase, uric acid, creatinine and BNP were higher in reduced cardiac function group than those of the normal cardiac function group. Renal insufficiency and cardiac function reduction were independent predictors of death during hospitalization. Conclusion Renal insufficiency and reduced cardiac function significantly increase the mortality during hospitalization.