ST段抬高型心肌梗死直接经皮冠状动脉介入术治疗预后危险因素及危险分层

Prognostic risk factors and risk stratification for patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

目的探讨行直接经皮冠状动脉介入术(primary percutaneous coronary intervention, pPCI)治疗的ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者院内主要心血管不良事件(major adverse cardiovascular events, MACEs)发生的危险因素并进行危险分层。方法行pPCI治疗的STEMI患者128例,依据术后10 d是否发生MACEs分为MACEs组62例,非MACEs组66例。记录患者一般资料,多因素logistic回归分析MACEs发生的危险因素,并根据OR值对危险因素进行危险分层。结果 MACEs组年龄、心率、ST段抬高总幅度、平均ST段抬高幅度,以及饮酒、下壁心肌梗死、Killip分级Ⅱ～Ⅲ级比率与非MACEs组比较差异均有统计学意义(P<0.05),体质量、左室射血分数等与非MACEs组比较差异均无统计学意义(P>0.05);年龄>60岁(OR=4.45,95%CI:1.65～12.04,P=0.003),入院时心率≤67次/min(OR=3.47, 95%CI:1.25～9.63,P=0.017)、ST段抬高总幅度≥1.15 mV (OR=10.08,95%CI:2.64～38.53,P=0.001)、下壁心肌梗死(OR=7.78,95%CI:2.11～28.69,P=0.002)、Killip分级Ⅱ级(OR=4.21, 95%CI:2.96～6.32,P<0.001)、Killip分级Ⅲ级(OR=8.38, 95%CI:4.56～13.53,P<0.001)是院内发生MACEs的危险因素;危险分层结果显示,高风险组院内MACEs发生率(86.54%)高于低风险组(22.37%)(P<0.05)。结论高龄(>60岁)、入院时心率(≤67次/min)、Killip分级Ⅱ～Ⅲ级、下壁心肌梗死及ST段抬高总幅度≥1.15 mV是STEMI患者行pPCI治疗后发生院内MACEs的危险因素,根据危险因素对患者进行危险分层有助于识别危重患者、及时行pPCI治疗。

Objective To investigate the risk factors for major adverse cardiovascular events(MACEs)in patients with ST-segment elevation myocardial infarction(STEMI)treated by primary percutaneous coronary intervention(pPCI)and to create risk stratification model.Methods Totally 128patients with STEMI treated with pPCI were divided into 62 patients with MACEs(MACEs group)and 66patients without MACEs(non-MACEs group)according to whether MACEs occurred by day 10after pPCI.The patient’s general data were recorded.Multivariate logistic regression analysis was performed to analyze the risk factors for MACEs,and the risk was stratified according to ORvalue.Results There were significant differences in the age,heart rate,sum magnitude of ST-segment elevation,average magnitude of STsegment elevation,alcohol consumption,inferior wall myocardial infarction and Killip classⅡ-Ⅲ(P<0.05),and no significant differences in the body mass and left ventricular ejection fraction between two groups(P>0.05).The age>60 years old(OR=4.45,95%CI:1.65-12.04,P=0.003),heart rate≤67beats/min at admission(OR=3.47,95%CI: 1.25-9.63,P=0.017),sum magnitude of ST-segment elevation≥1.15mV (OR=10.08,95%CI:2.64-38.53,P= 0.001),inferior wall myocardial infarction(OR=7.78,95%CI:2.11-28.69,P=0.002),Killip classⅡ(OR=4.21, 95%CI:2.96-6.32,P<0.001)and Killip classⅢ(OR=8.38,95%CI:4.56-13.53,P<0.001)were the risk factors for in-hospital MACEs.Risk stratification results showed that the incidence of MACEs was significantly higher in high-risk group(86.54%)than that in low-risk group(22.37%)(P<0.05).Conclusion The old age(>60years), heart rate≤67beats/min at admission,Killip classⅡ-Ⅲ,inferior wall myocardial infarction and sum magnitude of ST-segment elevation≥1.15mV are the risk factors for in-hospital MACEs in patients with STEMI after pPCI.Risk stratification is helpful to identify critically ill patients for pPCI treatment in time.