急诊PCI术后急性ST段抬高型心肌梗死合并左心室壁瘤的危险因素分析

An analysis of risk factors for acute ST segment-elevation myocardial infarction with left ventricular aneurysm after primary percutaneous coronary intervention

目的:探讨急诊PCI(primary percutaneous coronary intervention,pPCI)时代急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)合并左心室壁瘤(left ventricular aneurysm,LVA)的危险因素。方法:纳入锦州医科大学河南省人民医院2017年1月至2018年6月期间诊断为STEMI并行pPCI术的患者240例,按照是否发生LVA分为LVA组(32例)和非LVA组(208例),收集患者的基本信息、临床资料及辅助检查结果,建立logistic回归模型,对LVA形成的危险因素进行回顾性分析。结果:随着总缺血时间分级(<6 h、6~12 h、>12 h)的延长,LVA发生率逐渐升高(χ^2=12.40,P=0.000);多因素logistic回归分析显示,总缺血时间、入院时心率(beat per minute,bpm)、Killip分级(≥Ⅱ级)、≥4个相邻导联ST段抬高、PCI术后心肌梗死溶栓治疗试验(thrombolysis in myocardial infarction,TIMI)血流分级≤2级为LVA发生的独立危险因素,其比值比(odds ratio,OR)依次为1.400(95%CI=1.163~1.687,P=0.000)、1.054(95%CI=1.011~1.099,P=0.014)、14.041(95%CI=3.131~62.970,P=0.001)、7.419(95%CI=1.222~45.053,P=0.029)、12.034(95%CI=1.456~99.450,P=0.021);而既往心绞痛为LVA发生的保护因素,OR值为0.066(95%CI=0.010~0.424,P=0.004)。结论:心血管医生应及时评估LVA的形成风险,pPCI治疗且达到术后TIMI血流3级对于预防LVA的发生有重要意义。

Objective:To investigate the risk factors for acute ST segment elevation myocardial infarction(STEMI)with left ventricular aneurysm(LVA)after primary percutaneous coronary intervention(pPCI). Methods:A total of 240 patients who were diagnosed with STEMI and underwent pPCI in our hospital form January 2017 to June 2018 were divided into LVA group(n=32)and non-LVA group(n=208)according to the presence or absence of LVA. A logistic regression model was established based on the basic information of the patients as well as their clinical data and auxiliary examination results to retrospectively analyze the risk factors for LVA. Results:The incidence of LVA gradually increased with the grade of total ischemic time(<6 h,6-12 h,>12 h)(χ^2=12.40,P=0.000). The multivariate logistic regression analysis showed that total ischemic time(OR=1.400,95%CI=1.163 to 1.687,P=0.000),heart rate(beats per minute,bpm)on admission(OR=1.054,95%CI=1.011 to 1.099,P=0.014),Killip class ≥Ⅱ(OR=14.041,95%CI=3.131 to 62.970,P=0.001),≥4 adjacent leads with ST-segment elevation(OR=7.419,95%CI=1.222 to 45.053,P=0.029),and final thrombolysis in myocardial infarction(TIMI)flow grade ≤2 after PCI(OR=12.034,95%CI=1.456 to 99.450,P=0.021)were the independent risk factors for LVA. However,previous angina pectoris was a protective factor against LVA(OR=0.066,95%CI=0.010 to 0.424,P=0.004). Conclusion:Cardiovascular doctors should assess the risk of LVA in time. Achieving a TIMI flow grade 3 by pPCI may be important for preventing LVA.