脉压与急性ST段抬高型心肌梗死患者经皮冠状动脉介入术近期疗效的关系

The relationship between pulse pressure and short-term prognosis after primary percutaneous coronary intervention for acute ST segment elevated myocardial infarction

目的评价脉压与急性ST段抬高型心肌梗死（ASTEMI）患者行经皮冠状动脉介入术（PCI）近期疗效的关系。方法回顾性分析2011年1月至2015年6月ASTEMI行PCI治疗的患者389例,根据脉压分为A组：脉压≤20mm Hg,n=122;B组：脉压20~60mm Hg,n=138;C组：脉压〉60mm Hg,n=129。观察不同脉压组患者冠状动脉病变严重程度;PCI术前、术后罪犯血管心肌梗死溶栓试验（TIMI）的血流情况,恶性心律失常的发生情况;观察血清肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I（cTn-I）、血浆氨基末端脑钠尿肽前体（NT-proBNP）峰值情况;对比术后1周6min步行距离;对比术后1周死亡情况;对比PCI术后1周与术前脉压的变化。结果冠状动脉病变累及血管数与累及部位由轻及重依次为B组、C组、A组（均P〈0.05）;3组罪犯血管PCI术前血流情况差异有统计学意义,B组优于C组,更优于A组（均P〈0.05）,PCI术后差异无统计学意义（均P〉0.05）。术中、术后恶性心律失常的发生由少到多依次为B组、C组、A组,3组间差异有统计学意义（P〈0.05）。PCI术后CK-MB、cTn-I、NT-proBNP峰值3组间对比均表现为B组C组〉B组,3组间差异有统计学意义（均P〈0.05）。心源性休克是A组最重要的死亡原因,但3组间心源性死亡病因发生情况无统计学意义（均P〉0.05）。PCI术后A组脉压取得明显有益的改善。结论脉压对ASTEMI患者PCI近期预后有一定的预测作用。

Objective To investigate the prognostic significance of pulse pressure on in-hospital outcome of patients with acute ST segment elevated myocardial infarction（ASTEMI）undergoing percutaneous coronary intervention（PCI）. Methods Three hundred and eighty-nine ASTEMI patients received PCI from January 2011 to June 2015 were analyzed retrospectively. These patients were divided into three groups based on their pulse pressure（group A：pulse pressure≤20mm Hg,n=122;group B：pulse pressure 20-60 mm Hg,n=138;group C：pulse pressure60mm Hg,n=129. The severity of the coronary artery disease,thrombolysis in myocardial infarction（TIMI）grade of blood flow before and after PCI,malignant arrhythmia,concentration of creatine kinase isoenzyme-MB（CK-MB）,cardic troponin I（cTn-I）,N-terminal pro-brain natriuretic peptide（NT-proBNP）,as well as 6-min walking distance and death rate were compared a week after PCI. The changes of pulse pressure before and after PCI were compared. Results The severity of coronary artery disease,estimated by the site and number of affected vessels,ranged from mild to severe was group B,C and A（all P0.05）. There were significant differences of the blood flow in the infarction related vessels before PCI,Group A was the worst,while group B was better than C（all P0.05）. After PCI,the differences no longer had statistical significance（all P0.05）. During and after the PCI,the incidence of malignant arrhythmia ranged from less to more was group B,C,A with significant difference（all P0.05）. After PCI,the peak value of CK-MB,cTn-I and NT-proBNP in three groups showed as group Bgroup Cgroup A[CK-MB：（57.3±26.4）vs（89.4±39.6）vs（112.5±48.2）U/L,all P0.05;cTn-I：（11.8±5.2）vs（15.5±6.4）vs（35.0±16.9）μg/L,all P0.05;NT-proBNP：（1027.6±629.7）vs（2301.1±712.5）vs（3239.3±873.6）ng/L,all P0.05]. The result of 6-min walking distance test showed that group A were worst,group B was better than group C（all P0.05）. Group A also had the highest incidence of all-cause and cardiac-related death,while group B had the lowest（all P0.05）.Cardiac shock was the most important reason of cardiac death in group A,but there was no statistical difference of the reason of cardiac death among three groups.PCI improved pulse pressure of group A significantly. Conclusion Pulse pressure might be correlated with in-hospital prognosis in acute myocardial infarction（AMI）patients undergoing PCI.