ST段抬高型心肌梗死行急诊PCI治疗患者合并左心室收缩功能障碍的原因分析

The causes of left ventricular systolic dysfunction in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的探讨影响ST段抬高型心肌梗死(STEMI)急诊PCI后左心室收缩功能障碍(LVSD)的因素。方法 518例行急诊PCI的STEMI患者按心脏B超检查LVEF值是否≤40%,分为LVSD组和non-LVSD组,使用多因素Logistic回归分析与LVSD相关的因素。结果 LVSD组较non-LVSD组,在KillipⅢ/Ⅳ级、前壁心肌梗死、冠状动脉前降支(LAD)病变和多支病变、BNP≥400pg/mL和TnI>0.15μg/L的比例均较高,差异有统计学意义(均P<0.05)。LVSD组中罪犯血管以前降支或左主干(LAD/LM)为主,而non-LVSD组以非LAD/LM为主,差异有统计学意义(P<0.01)。多因素Logistic回归分析显示,发病到就诊时间>6h(OR=3.973,95%CI:2.175~7.259)、BNP≥400pg/mL(OR=2.221,95%CI:1.090~4.523)、多支血管病变(OR=3.514,95%CI:1.247~9.904)、前壁心肌梗死(OR=4.467,95%CI:2.165~9.216)、罪犯血管为LAD/LM(OR=3.908,95%CI:1.840~8.300)是发生LVSD的独立因素。结论发病到就诊时间>6h、BNP≥400pg/mL、多支血管病变、LAD/LM为罪犯血管、前壁心肌梗死与STEMI行急诊PCI患者发生LVSD有关。

Objective To investigate the factors influencing left ventricular systolic dysfunction（LVSD） in patients withST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PPCI）.Methods The clinical data of 518 patients with STEMI underwent PPCI were analyzed retrospectively. They were dividedinto LVSD group（left ventricular ejection fraction-LVEF≤40% ）and non-LVSD group（LVEF〉40% ）. A multivariate logisticregression analysis was performed to investigate the factors associated with LVSD. Results The proportions of Killip Ⅲ/Ⅳ, anterior wall myocardial infarction, left anterior descending artery and multi-vessel diseases, BNP≥ 400pg/mL, andTnI 〉 0.15滋g/L were significantly higher in LVSD group than non-LVSD group （all P〈0.05）. The most culprit vessels wereleft anterior descending artery /left main coronary artery （LAD /LM） in LVSD group, and non-LAD/LM in non-LVSD group（P〈0.01）. Multivariate Logistic regression analysis showed that the time from onset to diagnosis〉6h（OR= 3.973, 95%CI2.175-7.259）, BNP ≥ 400pg/mL（OR=2.221, 95%CI：1.090-4.523）, multi-vessel diseases（OR=3.514, 95%CI：1.247-9.904 ）,anterior wall myocardial infarction（OR=4.467, 95%CI： 2.165-9.216）and LAD/LM diseases（OR=3.908, 95%CI：1.840-8.300）were independent factors for the development of LVSD. Conclusion Time from onset to diagnosis〉6h, BNP≥400pg/ml,multi-vessel diseases, LAD/LM diseases, anterior wall myocardial infarction are associated with LVSD in patients withSTEMI undergoing primary PCI.