药物治疗和介入治疗对急性非ST段抬高型心肌梗死长期预后的影响

The long-term prognostic influence of drug therapy and interventional therapy to acute non-ST segment elevation acute myocardial infarction

目的探讨不同治疗方案对急性非ST段抬高型心肌梗死(NSTEMI)长期预后的影响。方法采用回顾性队列研究的方法,纳入2012年10月-2017年10月于新疆医科大学第一附属医院心脏中心确诊为NSTEMI的患者共计716例,分为介入治疗组(317例)和药物治疗组(399例),比较2组患者主要心脑血管不良事件(MACCE)的发生率,采用多因素COX回归分析法调整混杂因素的影响。结果在本研究中共计45例(6.25%)患者死亡,其中心源性死亡(包括恶性心律失常、急性左心衰竭、致死性心肌梗死)共计25例(3.4%)。出血共计51例(7.1%),MACCE共计205例(28.6%)。介入治疗组和药物治疗组在MACCE、卒中、再入院方面差异具有统计学意义(P<0.05)。通过COX回归模型分析,以MACCE作为因变量,以吸烟、饮酒、肌酐、低密度脂蛋白、脂蛋白a、肌钙蛋白T(CTnT)、左室舒末内径、高血压、糖尿病、PCI治疗作为自变量,统计结果分析显示,PCI治疗(OR=0.848,95%CI:0.386～0.876,P=0.009),脂蛋白a(OR=1.001,95%CI:1.000～1.002,P=0.038),吸烟(OR=1.430,95%CI:1.012～2.007,P=0.039)和糖尿病(OR=5.587,95%CI:3.501～8.917,P=0.000)与NSTEMI患者长期发生MACCE事件风险相关。结论与药物治疗相比,PCI治疗能明显改善患者的长期预后。

ObjectiveTo discuss the long-term prognostic influence on acute non-ST segment elevation acute myocardial infarction with different treatment regimens.Methods716 cases of patients with acute non-st-segment elevation myocardial infarction were enrolled in the Heart Center of the First Affiliated Hospital of Xinjiang Medical University by using the retrospective cohort study method,and divided into two groups:interventional therapy group(317 cases)and drug treatment group(399 cases).Multivariate COX regression analysis was used to adjust the influence of confounding factors.ResultsIn the study,a total of 45 patients(6.25%)died,including 25 patients(3.4%)with cardiac death(including malignant arrhythmia,acute left heart failure,and fatal myocardial infarction).There were 51 cases of hemorrhage(7.1%)and 205 cases of MACCE(28.6%).The differences in MACCE,stroke and readmission between the interventional therapy group and the drug therapy group were statistically significant(P<0.05).The results of COX regression model analysis showed that,MACCE as dependent variable,and smoking,drinking,creatinine,low density lipoprotein cholesterol(ldl-c),lipoprotein a and troponin T(CTnT)and left ventricular diameter,hypertension,diabetes,at the end of the PCI treatment as independent variables,the PCI therapy(OR=0.848,95%CI:0.386-0.876,P=0.009),lipoprotein a(OR=1.001,95%CI:1.000-1.002,P=0.038),smoking(OR=1.430,95%CI:1.012-2.007,P=0.039)and diabetes mellitus(OR=5.587,95%CI:3.501-8.917,P=0.000)were associated with the risk of long-term MACCE events in patients with NSTEMI.ConclusionCompared with drug therapy,PCI can improve the long-term prognosis of patients.