老年ST段抬高型心肌梗死患者急诊冠状动脉介入术后ST段回落的相关因素研究

ST segment resolution-related factors in elderly STEMI patients after PCI

目的探讨老年ST段抬高型心肌梗死患者(STEMI)急诊PCI后ST段回落(STR)的相关因素。方法连续入选直接PCI的老年STEMI患者354例,以术后心电图STR判断标准进行分组,采用巢式病例-对照研究方法,按1?2匹配,最终入选STR完全组(STR≥70%)78例和STR不良组(STR<70%)156例,分析2组基线资料、手术情况,采用多因素logistic逐步回归分析STR的影响因素。结果STR完全组与STR不良组糖尿病(28.2%vs 43.6%,P=0.023);胸痛到球囊扩张时间[(5.0±2.5)h vs(6.8±4.8)h,P=0.002];心功能Killip分级Ⅰ~Ⅱ级(84.6%vs 70.5%,P=0.019);前壁伴或不伴高侧壁心肌梗死(25.6%vs 55.1%,P=0.000);早期肝素使用(59.0%vs 42.3%,P=0.016)比较,差异有统计学意义。糖尿病(OR=4.404,95%CI:1.322~14.987,P=0.043);胸痛到球囊扩张时间(OR=0.975,95%CI:0.975~0.986,P=0.026);前壁伴或不伴高侧壁心肌梗死(OR=4.758,95%CI:1.482~15.354,P=0.009)为STR不良的影响因素。结论糖尿病、胸痛到球囊扩张时间、前壁伴或不伴高侧壁心肌梗死是老年STEMI患者急诊PCI后STR的独立预后因素。

Objective To study the ST segment resolution(STR)-related factors in elderly STEMI patients after PCI.Methods Three hundred and fifty-four elderly STEMI patients were divided into complete STR group or STR≥70%group(n=78)and incomplete STR group or STR<70%group(n=156).Their baseline data,surgical procedures and risk factors for STR were analyzed by multivariate logistic regression analysis.Results The incidence of DM was significantly lower,the time from chest pain to ballon dilation was significantly shorter,the ratio of cardiac function Killip classificationⅠ-Ⅱand the ratio of early heparin injection were significantly higher and the incidence of anterior wall with or without high lateral wall infarction was significantly lower in complete STR group than in incomplete STR group(28.2%vs 43.6%,P=0.023;5.0±2.5 h vs 6.8±4.8 h,P=0.002;84.6%vs 70.5%,P=0.019;59.0%vs 42.3%,P=0.016;25.6%vs 55.1%,P=0.000).DM,time from chest pain to ballon dilation and anterior wall with or without high lateral wall infarction were the independent risk factors for STR in elderly STEMI patients after PCI(OR=4.404,95%CI:1.322-14.987,P=0.043;OR=0.975,95%CI:0.975-0.986,P=0.026;OR=4.758,95%CI:1.482-15.354,P=0.009).Conclusion DM,time from chest pain to ballon dilation and anterior wall with or without high lateral wall infarction are the independent risk factors for STR in elderly STEMI patients after PCI.