早期心包积液对急性ST段抬高型心肌梗死患者12个月死亡率的影响

Effect of early pericardial effusion on 12-month mortality in patients with acute ST-segment elevation myocardial infarction

目的评估心包积液(PE)在接受直接经皮冠状动脉介入(PPCI)治疗的急性ST段抬高型心肌梗死(STEMI)患者中的发生率,探讨早期PE对行PPCI治疗的STEMI患者12个月死亡率的影响。方法本研究为回顾性研究。连续收集自2012年1月27日至2014年12月31日在武汉亚洲心脏病医院接受PPCI治疗的STEMI患者678例,并依据出院前超声心动图检查是否存在PE分为两组,即研究组(PE> 5. 0 mm,114例)与对照组(无PE,564例)。分析两组基线临床资料、冠状动脉影像特征、PCI相关数据及PPCI术后12个月死亡率。结果 678例患者住院期间超声心动图检查显示PE发生率16. 8%,其中中-大量PE(PE≥10. 0 mm)占5. 6%。研究组住院期间死亡率(7. 0%比2. 1%,χ~2=7. 921,P=0. 005)和12个月死亡率(16. 7%比7. 8%,χ~2=8. 843,P=0. 003)均显著高于对照组。中-大量PE患者(38例)的12个月死亡率显著高于较少量PE患者(PE <10. 0 mm,76例)(28. 9%比10. 5%,χ~2=6. 189,P=0. 013)。多因素logistic回归分析显示,2型糖尿病、合并急性心力衰竭、PPCI术后慢血流/无复流、肌钙蛋白I峰值> 100 ng/ml、N末端B型利钠肽原峰值> 5 000 pg/ml、高敏C反应蛋白峰值> 100 mg/L是PE发生的独立危险因素(均为P <0. 05)。结论 STEMI合并早期PE增加PPCI术后12个月死亡风险。

Objective To investigate the incidence of early pericardial effusion (PE) in patients with acute ST-segment elevated myocardial infarction (STEMI) who undergoing primary percutaneous coronary artery intervention (PPCI) and to explore the effect of early PE on 12-month mortality after PPCI. Methods This study is a retrospective study. A total of 678 consecutive STEMI patients who underwent PPCI were enrolled in this study from January 2012 to December 2014 in Wuhan Asia Heart Hospital. There were two groups of PE, namely the study group (PE>5.0 mm, 114 cases) and the control group (no PE, 564 cases). The baseline clinical data, angiographic features, data related to PPCI, the 12-month mortality were analyzed retrospectively. Results PE was detected in 114 patients (16.8%) by echocardiography during hospitalization. The incidence of moderate-to-severe PE (MPE) which was defined PE≥10 mm was 5.6%. Compared with control group, in-hospital mortality (7.0% vs. 2.1%,χ^2=7.921, P=0.005) and 12-month mortality (28.9% vs. 10.5%,χ^2=8.843,P=0.003) in study group was significantly higher. Moreover, the mortality in MPE group was significantly higher than the mild PE group whose PE<10 mm (28.9% vs. 10.5%,χ^2=6.189, P=0.013). The multivariate logistic analysis revealed that Type 2 diabetes mellitus, acute heart failure, slow or no flow after PPCI, peak troponin Ⅰ>100 ng/ml, peak NT-proBNP>5 000 pg/ml and peak hs-CRP>100 mg/L were independent predictors for PE incidence (all P< 0.05). Conclusions Early PE after STEMI is related to increased mortality at 12 months after PPCI.