冠状动脉钙化积分对经皮冠状动脉介入治疗心肌梗死合并心力衰竭患者预后的预测价值

Predictive value of coronary calcium score on prognoses of patients with myocardial infarction complicated with heart failure after percutaneous coronary intervention

目的 探究冠状动脉钙化积分(CCS)对经皮冠状动脉介入(PCI)治疗心肌梗死合并心力衰竭患者预后的预测价值.方法 回顾性分析2014年3月至2019年3月濮阳市人民医院收治的121例心肌梗死合并心力衰竭患者的临床资料.所有患者均为首次进行PCI治疗,术前均接受冠状动脉CT检查并计算CCS,根据CCS水平分为A组(CCS≤100,n=37)、B组(100400,n=39).比较三组患者冠状动脉病变情况以及PCI治疗后完全血运重建率的差异,随访12个月,记录主要心血管不良事件(MACE)发生情况,绘制三组患者PCI治疗后累积无MACE发生的生存曲线图,比较无MACE累积生存率的差异性.结果 C组患者多支血管病变率高于A组和B组(χ2=15.253、11.895,P<0.05),A组和B组多支血管病变率比较差异未见统计学意义(P>0.05);三组冠状动脉病变Gensini积分比较,A组0.05).随访12个月,Kaplan-Meier生存分析发现,三组患者无MACE累积生存率比较,A组>B组>C组,差异有统计学意义(P<0.05);Cox多因素回归分析结果显示,校正年龄后,CCS>400是心肌梗死合并心力衰竭患者PCI治疗后MACE发生的独立预测因子(P<0.05).结论 心肌梗死合并心力衰竭患者CCS水平越高则冠状动脉病变越严重,PCI治疗后MACE发生率也就越高,CCS是预后不良的强有力的预测因子.

Objective To investigate the predictive value of coronary calcium score(CCS)on prognoses of patients with myocardial infarction complicated with heart failure after percutaneous coronary intervention(PCI).Methods The clinical data from 121 patients with myocardial infarction complicated with heart failure admitted to Puyang People’s Hospital from March 2014 to March 2019 were retrospectively analyzed.All patients were given PCI for the first time,and given coronary computed tomography(CT)examination to calculate CCS.The patients were divided into group A(CCS≤100,n=37),group B(100<CCS≤400,n=45)and group C(CCS>400,n=39)according to CCS levels.The differences of coronary artery lesions and complete target vessel revascularization rate after PCI were compared among the three groups.The occurrence of major adverse cardiovascular events(MACE)was recorded during 12 months of folllow-up.The survival curves of three groups without MACE after PCI were drawn,and the difference of cumulative survival rate of without MACE was compared.Results The incidence of multivessel disease in group C was higher than that in group A and B(χ2=15.253,11.895;P<0.05),but there was no significant difference in incidence of multivessel disease between group A and group B(P>0.05).The Gensini score of coronary artery lesion in the group C was the highest,followed by group B and group C(P<0.05),and there was no statistically significant difference in the complete target vessel revascularization rate among the three groups(P>0.05).After patients were followed up for 12 months,Kaplan-Meier survival analysis found that the cumulative survival rate of without MACE in the group A was the highest,followed by group B and group C(P<0.05).Cox multivariate regression analysis showed that after age was adjusted,CCS>400 was an independent predictor of MACE after PCI in patients with myocardial infarction complicated with heart failure(P<0.05).Conclusions In patients with myocardial infarction complicated with heart failure,the coronary lesions gets worse and the incidence of MACE after PCI gets higher,with the increase in CCS level.CCS is a powerful predictor of poor prognosis.