老年ST段抬高型心肌梗死患者急诊冠脉介入后发生左心室重构的相关因素研究

The analysis of risk factors of left ventricular remodeling after primary percutaneous coronary intervention in the eldly with ST segment elevation myocardial infarction

目的分析老年sT段抬高型心肌梗死患者急诊冠脉介入后发生左心室重构的相关预后因素。方法2013年1月～2015年12月本院就诊的246例急诊冠脉介入的sT段抬高型心肌梗死患者，对其中发生的左心室重构患者44例（病例组），采用巢式病例一对照研究方法，按1：4匹配未发生左心室重构病例176例作为对照组，通过logistic逐步回归分析左心室重构的预后因素。结果单因素分析显示糖尿病、肾功能不全、吸烟、前壁伴或不伴高侧壁心梗、下壁伴或不伴后壁右室心梗、造影且行PCI．未行PCI但TIMI血流恢复Ⅲ级、梗死血管最终TIMI血流Ⅲ级、β受体阻滞剂、ACEI／ARB、螺内酯是左心室重构的预后因素。多因素Logistic回归分析显示糖尿病、高血压、吸烟、前壁伴或不伴高侧壁、最终IRA血流TIMIIII级，β受体阻滞剂、ACEI／ARB类药物是老年sT段抬高型心肌梗死患者急诊冠脉介入后发生左心室重构的独立预后因素。结论糖尿病、高血压、吸烟、前壁伴或不伴高侧壁、最终IRA血流TIMIm级，β受体阻滞剂、ACEI／ARB类药物是老年sT段抬高型心肌梗死患者急诊冠脉介入后发生心室重构的独立预后因素。

Objective To evaluate the risk factors of left ventricular （LV） remodeling after primary percutaneous coronary intervention（PCI） in the eldly with ST segment elevation myocardial infarction（STEMI）. Methods The information was performed from the General Hospital of Huabei Oil field. A total of 246 gerontal patients were recruited with STEMI gived PCI from January 2013 to December 2015, among which 44 cases were diagnosed LV remodeling. 176 cases with similar onset date of disease were explored as the control group according to the principle of the nested case-control design. The logistic regression analysis was performed to identify independent predictors of LV remodeling after PCI. Results Univariate analysis showed that diabetes,renal failure,smoke, anterior wall with or without high lateral wall myocardial infarction, inferior wall with or without posterior wall or right ventricular myocardial infarction, coronary angiography（CAG） and PCI, no PCI but the infarct-related artery（IRA） flow TIMI Ill, IRA now TIMI m finally, β blockers, ACEI/ARB, spironolactone were prognostic factors for LV remodeling. Logistic regression analysis showed that patients with diabetes, hypertension, smoke, anterior wall with or without high lateral wall myocardial infarction, IRA flow TIMI m finally, β blockers, ACEI/ARB are independent prognostic factors for LV remodeling in the eldly. Conclusion Diabetes, hypertension, smoke, anterior wall with or without high lateral wall myocardial infarction, IRA flow TIMI m finally, β blockers, ACEI/ARB were independent prognostic factors for the LV remodeling after PCI in the eldly.