IABP辅助直接PCI治疗急性ST段抬高型心肌梗死合并心源性休克的效果和危险因素分析

Effect and risk factors forshort -term mortalityin patients with acute ST -segment elevatedmyocardial infarction and cardiogenic shocktreated with primary PCI and IABP

目的探讨影响主动脉内球囊反搏（IABP）辅助直接PCI治疗急性sT段抬高型心肌梗死（STEMI）合并心源性休克患者30d病死率的危险因素。方法回顾性分析开封市中心医院心内科自2011—01—2015—12收治并应用IABP辅助PCI治疗STEMI合并心源性休克患者53例及同期未应用IABP辅助治疗的STEMI合并心源性休克患者54例，比较术前、术中和术后情况的变化以及随访30d病死率，并应用Kaplan—Meier生存分析评价两组的生存情况，Logistic回归分析30d病死率的危险因素，受试者工作特征性曲线评估相应的敏感性和特异性。结果入选的107例患者中，男性65例，女性42例，平均年龄（63．8±11．3）岁，入院平均动脉压为（64．3±14．4）mmHg。两组间年龄、术前平均动脉压、血肌酐、进门一球囊扩张时间、术后CK—MB和cTnI峰值、心电图ST段回落等差异均有统计学意义（P〈0．05）。此外，两组患者应用血管活性药物的时间、机械通气比例、CCU住院时间、急性肾损伤等差异均有统计学意义（P〈0．05）。随访30d时，死亡32例。Kaplan—Meier生存分析两组间的中位生存时间差异无统计学意义（P〉0．05）。Logistic回归分析发现年龄（OR1．10，95％CI1．02—1．27，P=0．003）、D2B（OR1．54，95％CI1．17～1．93，P=0．04）、急性肾损伤（OR2．58，95％CI1．82—3．57，P=0．02）和IABP再置入（OR3．43，95％CI，2．33—4．85，P=0．01）为预测30d病死率的重要影响因素。结论IABP有助于稳定STEMI合并心源性休克患者的血流动力学，但对短期病死率无显著影响。

Objective The aim of this study was to evaluate therisk factors formortalityin patients with acute ST- segment elevated myocardial infarction （ASTEMI） and cardiogenic shock （CS） treated with intra aortic balloon pump （IABP） - supported primary PCI. Methods Fifty - four STEMI and CS patients with IABP supported PCI in Kaifeng Central Hospital from January 2011 to December 2015 were involved in IABP group and 54 patients without IABP support were involved in control group. We compared the pre -procedural, procedural and post- procedural clinical characteristics between the two groups. Furthermore,we used the Kaplan - Meier survival analysis to evaluate the survival benefit, Logistic regression to evaluate the risk factors for 30 - day mortality and receptor - operating characteristic （ROC） curves for sensitivity and specificity. Results Of the 107patients enrolled, there were 65 males and 42 females. The mean age was （63.8 ± 11.3 ） year - old, and mean arterial blood pressure （MAP） was（64.3 ± 14.4）mm Hg. Clinical characteristics, such as age, mean arterial blood pressure, creatinine level, door- to -balloon time （D2B） , peak level of CK- MB and cTnI after PCI, ST depression were significantly different between groups （ P 〈 0. 05 ）. Additionally, duration of vasopressor usage, mechanical ventilation, days stayed in CCU and acute kidney injury （AKI）were also markedly different between the groups（P 〉 0.05）. At 30 - day follow - up, 32 patients died. Kaplan - Meier analysis showed similar survival between groups. Logistic regression analyses demonstrated that age （ORI. 10, 95% CI 1.02-1.27, P=0. 003）,D2B （OR 1.54, 95% CI 1.17-1.93, P=0.04）, AKI （OR 2.58, 95% CI 1.82 -3.57 ,P =0.02） and IABP re-insertion （OR 3.43, 95% CI 2.33 - 4.85, P = 0.01 ） were all risk factors for 30 - day mortality. Conclusion ABP support was associated with stable hemodynamie status, although no survival benefit. Additionally, IABP re - insertion, age, D2B and AKI were risk factors for short - term mortality in patients with STEMI and CS.