非ST段抬高型急性冠状动脉综合征患者经皮冠状动脉介入治疗术后心功能不全相关因素分析

Analysis of factors related to cardiac dysfunctions in patients with non-ST segment elevation acute coronary syndrome after percutaneous coronary intervention

目的探讨非ST段抬高型急性冠状动脉综合征(NSTEACS)患者经皮冠状动脉介入治疗(PCI)后发生心功能不全的相关因素。方法登录青岛市第八人民医院电子病历管理系统,收集2007年9月至2018年6月住院诊断为NSTEACS并行PCI的患者。PCI术后1周内出现心功能不全(≥Killip分级Ⅱ级)患者入病例组,PCI术后1周内心功能正常(Killip分级Ⅰ级)患者入对照组。对两组患者年龄、性别、高血压病史、2型糖尿病病史、高胆固醇血症史、吸烟史、饮酒史、心肌梗死病史、NSTEACS危险分层、血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂应用、冠状动脉SYNTAX积分、PCI术中对比剂剂量、入院24 h内心肌肌钙蛋白T(cTnT)峰值以及脑钠肽前体(NT-proBNP)峰值首先进行基线资料比较,然后将差异有统计学意义(P<0.05)的研究因素进行多因素Logistc回归分析,并采用向后法、似然比检验进行变量筛选。结果总计入选3413例接受PCI术的NSTEACS患者,剔除信息不全者,313例患者入病例组,2906例患者入对照组。经多因素Logistc回归分析以及向后法、似然比检验进行变量筛选,结果显示,年龄>80岁(OR=1.758,95%CI 1.129~2.367,P=0.014)、增加对比剂剂量(OR=1.083,95%CI 1.007~1.274,P=0.020)、入院24 h内cTnT峰值>0.2µg/L(OR=2.102,95%CI 1.703~3.104,P=0.031)以及NT-proBNP峰值>450 ng/L(OR=2.243,95%CI 1.863~3.257,P=0.015)为心功能不全发生的危险因素。结论高龄(>80岁)、PCI术中增加对比剂剂量、入院后24 h内cTnT峰值>0.2µg/L以及NT-proBNP峰值>450 ng/L会增加NSTEACS患者PCI术后发生心功能不全风险。

Objective To investigate the factors related to cardiac dysfunctions during the percutaneous coronary intervention(PCI)in patients with non-ST segment elevation acute coronary syndrome(NSTEACS).Methods Patients diagnosed as NSTEACS receiving PCI from September 2007 to June 2018 were collected in the data base of medical record management system in Qingdao Eighth People′s Hospital.Patients with cardiac dysfunctions(≥KillipⅡgrade)within 1 week after PCI were included into the case group,while patients with normal cardiac function(KillipⅠgrade)within 1 week after PCI were included into the control group.Firstly,baseline data of age,gender,histories of hypertension,histories of type 2 diabetes,histories of high cholesterol,histories of smoking,histories of drinking,histories of myocardial infarction,NSTEACS risk stratifications,the application of platelet glycoprotein(GP)Ⅱb/Ⅲa receptor antagonists,coronary artery SYNTAX scores,the dose of contrast agent during PCI,the peak cardiac troponin(cTnT)and N-terminal pro-brain natriuretic peptide(NT-proBNP)within 24 h after admission was compared between the two groups;then,factors with statistical differences(P<0.05)were analyzed by the multivariate logistic regression;at last,variables screening was performed through the backward method and likelihood ratio test.Results A total of 3927 patients with NSTEACS receiving PCI were enrolled.After patients with incomplete information were eliminated,313 patients were admitted to the case group and 2906 patients were admitted to the controlled group.After the analysis of multivariate logistic regression and variables screening,it showed that>80 years old(OR=1.758,95%CI 1.129 to 2.367,P=0.014),increased dose of contrast agent(OR=1.083,95%CI 1.007 to 1.274,P=0.020),the peak cTnT>0.2μg/L(OR=2.102,95%CI 1.703 to 3.104,P=0.031)and NT-proBNP>450 ng/L(OR=2.243,95%CI 1.863 to 3.257,P=0.015)after admission were the risk factors of cardiac dysfunctions.Conclusions Advanced age(>80 years old),increased dose of contrast agent during PCI,the peak cTnT>0.2μg/L and NT-proBNP>450 ng/L within 24 h after admission could raise the risk of cardiac dysfunctions in patients with NSTEACS after PCI.