影响急性下壁心肌梗死经皮冠状动脉介入治疗术中发生心室纤颤患者预后的危险因素分析

Analysis on prognostic risk factors of patients with acute inferior myocardial infarction and intra-operative occurrence of ventricular fibrillation when undergoing emergency percutaneous coronary intervention

目的观察影响急性下壁心肌梗死急诊经皮冠状动脉(冠脉)介入治疗(PCI)术中并发心室纤颤(VF)患者预后的危险因素.方法回顾性分析2016年5月至2018年5月沧州市人民医院治疗的52例急性下壁心肌梗死患者的临床资料.根据随访1年期间是否发生心血管事件分为预后不良组(19例)和预后良好组(33例).记录两组患者性别、年龄、有无吸烟史、糖尿病史、高血压病史、高脂血症史和近3d内左室射血分数(LVEF)、心梗面积(IS)和冠脉Gensini评分;将单因素分析中有统计学意义的指标纳入多元Logistic回归分析,筛选出影响急性下壁心肌梗死急诊PCI术中发生VF患者预后的危险因素;绘制受试者工作特征曲线(ROC)评价冠脉Gensini评分及IS对急性下壁心肌梗死急诊PCI患者术中发生VF的预测价值.结果52例患者中随访期间发生VF19例,发生率为36.5%.预后不良组IS、冠脉Gensini评分(分)均明显高于预后良好组〔IS:(3.2±0.2)%比(2.5±0.4)%,冠脉Gensini评分:98.8±12.5比85.7±8.4,均P<0.05〕,LVEF明显低于预后良好组(0.37±0.08比0.46±0.11,P<0.05).多因素Logistic回归分析显示:IS〔优势比(OR)=5.016〕、冠脉Gensini评分(OR=2.415)是急性下壁心肌梗死急诊PCI术中VF患者心血管事件发生的危险因素(均P<0.05).ROC曲线分析显示:IS、冠脉Gensini评分对急性下壁心肌梗死急诊PCI术中发生VF患者预后均有一定预测价值,ROC曲线下面积(AUC)分别为0.863、0.597,说明IS有中等预测价值,冠脉Gensini评分预测价值偏低,当IS最佳截断值为3.0cm时,其敏感度为89.4%,特异度为88.0%.结论高Gensini评分及IS是急性下壁心肌梗死急诊PCI术中发生VF患者预后的危险因素.

Objective To investigate the prognostic risk factors of patients with acute inferior myocardial infarction and intra-operative occurrence of ventricular fibrillation(VF)when undergoing emergency percutaneous coronary intervention(PCI).Methods The data of 52 patients with acute inferior myocardial infarction treated in Cangzhou City People's Hospital from May 2016 to May 2018 were retrospectively analyzed,and they were divided into poor prognosis group(19 cases)and good prognosis group(33 cases)according to whether cardiovascular events occurred during 1 year of follow-up.The patients'gender,age,smoking or not,histories of diabetes,hypertension,hyperlipidemia,and the results of well performed color echocardiography within recent 3 days,such as left ventricular ejection fraction(LVEF),cardiac infarction size(IS),and coronary Gensini score were recorded in the two groups;the indicators with statistical significance in univariate analysis were included in the multivariate logistic regression analysis to screen out the prognostic risk factors of patients with acute inferior wall myocardial infarction undergoing emergency PCI and occurrence of intra-operative VF;Receiver operating characteristic(ROC)curve was drawn to evaluate the values of coronary Gensini score and IS in predicting intraoperative occurrence of VF in patients with acute inferior wall myocardial infarction undergoing emergency PCI.Results During 1-year follow-up,19 of 52 patients with acute inferior myocardial infarction occurred VF,the incidence being 36.5%.The univariate analysis showed that the IS and Gensini score in poor prognosis group were significantly higher than those in the good prognosis group[IS:(3.2±0.2)%vs.(2.5±0.4)%,Gensini score:98.8±12.5 vs.85.7±8.4,both P<0.05],the LVEF level was significantly lower in the poor prognosis group than that in the good prognosis group(0.37±0.08 vs.0.46±0.11,P<0.05).The multivariate Logistic regression analysis showed that IS[odds ratio(OR)=5.016]and coronary Gensini score(OR=2.415)were the risk factors of occurrence of cardiovascular events after surgery in patients with acute inferior myocardial infarction and intra-operative VF when undergoing PCI(P<0.05).The ROC curve analysis showed that IS and coronary Gensini scores had certain predictive values for the prognosis of patients with acute inferior myocardial infarction and occurrence of intra-operative VF when undergoing emergency PCI,the area under the ROC curve(AUC)was 0.863 and 0.597,respectively,indicating that IS had a medium predictive value,while the value of coronary Gensini score was lower,when the IS optimal cut off value was 3.0,the sensitivity was 89.4%and the specificity was 88.0%.Conclusion High IS and Gensini score are the risk factors of prognosis of patients with acute inferior myocardial infarction and intra-operative occurrence of VF when undergoing emergency PCI.