合并心力衰竭ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗临床疗效分析

Primary percutaneous coronary intervention in patients with heart failure with ST segment elevation myocardial infarction

目的探讨心力衰竭对直接经皮冠状动脉介入术(PPCI)治疗急性ST段抬高型心肌梗死(STEMI)患者院内疗效的影响。方法回顾性分析全军心血管介入诊疗管理系统中接受PPCI治疗的8 760例STEMI患者的临床资料。根据有无合并心力衰竭将STEMI患者分为常规组(KILLIPⅠ级,n=7 787)与观察组(KILLIPⅡ~Ⅳ级,n=973)。比较两组患者的救治时间指标、临床各项主要指标、院内死亡事件及其他临床心脏不良事件发生情况等。结果观察组患者发病年龄以及女性、高脂血症、既往陈旧性心肌梗死病史、入院诊断为前壁心肌梗死患者比例明显高于常规组,两组比较,差异均有统计学意义(P<0.05)。观察组介入术中主动脉内囊反搏术应用比例、D2B时间、三支血管病变比例明显高于常规组,而单支血管病变比例低于常规组,两组比较,差异均有统计学意义(P<0.05)。观察组院内病死率明显高于常规组,其中,观察组术中、术后病死率均高于常规组,两组比较,差异均有统计学意义(P<0.05)。二元Logistic逐步回归分析发现,年龄、前壁心肌梗死及D2B时间是STEMI患者发生心力衰竭的独立危险因素(P<0.05)。结论合并心力衰竭的STEMI患者PPCI院内病死率增高,针对发生心力衰竭的独立预测因子,应尽量缩短D2B时间,积极优化围术期救治策略,减少心力衰竭的发生,以期降低患者院内病死率,改善长期预后。

Objective To investigate the effect of direct percutaneous coronary intervention(PPCI) on the in-hospital efficacy of acute ST-segment elevation myocardial infarction(STEMI) in patients with heart failure.Methods A retrospective analysis of 8 760 STEMI patients treated with PPCI in the PLA cardiovascular intervention management system was conducted.According to the presence of merge heart failure in patients with STEMI divided into conventional group(KILLIP LevelⅠ,n=787) and the observation group(KILLIP Level Ⅱ-Ⅳ,n=973).The time of treatment,main clinical indicators,death in hospital and other clinical adverse cardiac events were compared between the two groups.Results The age of onset,the proportion of female patients,The proportion of patients with hyperlipidemia,the history of previous myocardial infarction and the proportion of patients admitted to the hospital diagnosed as anterior myocardial infarction in the observation group were significantly higher than those in the conventional group,and the difference between the two groups was statistically significant(P<0.05).The proportion of intra-aortic balloon pump application,D2 B time and the proportion of three-vessel lesions in the intervention group were significantly higher than that in the conventional group,while the proportion of single-vessel lesions was lower than that in the conventional group(P<0.05).The nosocomial mortality of the observation group was significantly higher than that of the conventional group,among which,the intraoperative and postoperative mortality of the observation group was higher than that of the conventional group(P<0.05).Binary Logistic stepwise regression analysis showed that age,anterior wall myocardial infarction and D2 B time were independent risk factors for heart failure after STEMI(P<0.05).Conclusion The mortality of STEMI patients with heart failure combined with PPCI in hospital is increased.For independent predictors of heart failure,the time of D2 B should be shortened as far as possible,perioperative treatment strategy should be actively optimized,and the incidence of heart failure should be reduced,so as to reduce the mortality of patients in hospital and improve long-term prognosis.