高血压病对急性心肌梗死并发心源性休克患者主动脉内球囊反搏辅助下行急诊经皮冠状动脉介入治疗预后的影响

The effect of hypertension on prognosis of patients with acute myocardial infarction and cardiogenic shock receiving primary coronary intervention assisted by intra-aortic balloon pump

目的观察高血压病对急性心肌梗死(acute myocardial infarction,AMI)并发心源性休克(cardiac shock,CS)患者在主动脉内球囊反搏(intra-aortic balloon pump,IABP)辅助下行急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)预后的影响。方法回顾性分析2010年3月至2016年1月在中国科学技术大学附属第一医院心内科因AMI并发CS在IABP辅助下行急诊PCI的100例患者。根据是否有高血压病史分为高血压病组(57例)、非高血压病组(43例)。收集患者基线资料,比较两组患者围术期、术后3个月及1年的出血事件和主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCE),包括支架内血栓形成、支架内再狭窄、再发心肌梗死、心血管事件死亡、卒中及全因死亡事件发生情况。结果两组患者年龄、性别、慢性肾功能不全比例、吸烟史、心血管疾病家族史、术前血红蛋白水平、血小板计数比较,差异均无统计学意义(均P>0.05)。高血压病组合并2型糖尿病比例(33.3%比14.0%,P=0.027)、卒中史比例(24.6%比2.3%,P=0.002)均大于非高血压病组,差异均有统计学意义。与非高血压病组相比,高血压病组围术期、术后3个月及1年的大出血事件发生率、心血管事件死亡率、卒中比例、全因死亡率及总MACCE发生率较高,但差异均无统计学意义(均P>0.05)。Cox多因素回归分析结果显示,高血压病与AMI并发CS患者在IABP辅助下行急诊PCI的心血管事件死亡率及全因死亡率无显著相关性。结论虽然高血压病对AMI并发CS患者在IABP辅助下行急诊PCI预后的影响不显著,但仍需对合并高血压病的患者进行监护,警惕出血事件和MACCE的发生。

Objective To explore the effect of hypertension on prognosis of patients with acute myocardial infarction(AMI)and cardiac shock(CS)who received emergency revascularization assisted by intra-aortic balloon pump(IABP).Methods We retrospectively analyzed100patients with AMI and CS who had received emergency revascularization assisted by IABP between March,2010to January,2016.The patients were divided into the hypertension group(n=57)and the non-hypertension group(n=43)according to the history of hypertension.Bleeding events and major adverse cardiovascular and cerebrovascular events(MACCE)including stent thrombosis,recurrent myocardial infraction,cardiac death,stroke and all-cause death during perioperative period and at3months and one year after PCI.Results There were no signifi cant diff erences between the two groups in baseline information except the history of diabetes(33.3%vs.14%,P=0.027)and stroke(24.6%vs.2.3%,P=0.002).The rate of bleeding events and MACCE had no diff erence between the two groups(P>0.05).Cox regression analysis showed that there was no signifi cant correlation between clinical outcomes of emergency coronary revascularization assisted by IABP in AMI patients combined with CS and hypertension.Conclusions Hypertension showed no signifi cant eff ect on the prognosis of patients with acute myocardial infarction and cardiogenic shock receiving emergency revascularization assisted by intraaortic balloon pump,special care should be implemented to AMI patients comorbid with hypertension in order to reduce the incidence of hemorrhage and MACCE.