急性ST段抬高型心肌梗死左心室附壁血栓发生率及其危险因素调查

Incidence,risk factors and treatment of left ventricular thrombus in patients after anterior or extensive anterior ST-segment elevation myocardial infarction undergoing emergent percutaneous coronary intervention

目的探讨急性广泛前壁或前壁ST段抬高型心肌梗死(STEMI)左心室附壁血栓(LVT)的发生率、危险因素及体循环栓塞发生率、治疗方案和预后。方法回顾性纳入2014年1月1日至2017年12月31日就诊于中国医学科学院阜外医院的急性广泛前壁或前壁STEMI患者1245例。收集1245例患者急诊就诊时、直接经皮冠状动脉介入治疗(PCI)术后当日、PCI术后连续3 d以及术后1周经胸超声心动图(TTE)检查结果,根据结果诊断LVT者39例,并以简单随机法抽取40例无LVT者作为对照组。对两组患者进行随访,主要临床终点为体循环栓塞事件。结果LVT组共39例(3.1%,39/1245),39例患者中广泛前壁STEMI 26例(66.7%)、前壁STEMI 13例(33.3%);非LVT组40例。两组随访12个月,LVT组体循环栓塞1例(2.6%),非LVT组体循环栓塞0例;LVEF<40%是发生LVT的独立危险因素(OR 11.696,95%CI 2.620~52.215,P=0.001)。结论LVT在急性广泛前壁或前壁STEMI患者中发病率为3.1%,体循环栓塞事件发生率为2.6%。LVEF<40%为LVT发生的独立危险因素。

Objective To investigate the incidence,risk factors,incidence of systemic embolism(SE),treatment and prognosis in patients with left ventricular thrombus(LVT)after acute anterior or extensive anterior ST-segment elevation myocardial infarction(STEMI).Methods The data of 1245 patients with anterior or extensive anterior STEMI admitted to Fuwai Hospital,Chinese Academy of Medical Science from January 1,2014 to December 31,2017 were retrospectively analyzed.LVT was diagnosed by transthoracic echocardiographis at emergency department,on the day of PCI,3 days after PCI and 1 week after PCI.Incidence and risk factors of LVT and SE were analyzed.Results LVT was diagnosed in 39(3.1%)of 1245 patients,26(66.7%)with extensive anterior STEMI and 13(33.3%)with anterior STEMI.SE occurred in 1 of 39 patients(2.6%)with LVT during 12 months of followup,and no SE was found in 40 patients without LVT;Reduced LVEF(<40%)was more frequently observed in LVT patients and predict LVT(OR 11.696,95%CI 2.620–52.215,P=0.001).Conclusions In patients after anterior or extensive anterior STEMI,LVT was detected in 3.1%by echocardiography and SE occurred in 2.6%of patients with LVT during within 12 months follow-up.Reduced LVEF(<40%)was an independent risk factor for LVT.