老年急性ST段抬高型心肌梗死患者左心室血栓形成的发生率、预测因素、治疗策略和预后研究

Incidence,predictors,treatment strategies and prognosis of left ventricular thrombosis in elderly patients with acute ST-segment elevation myocardial infarction

目的探讨老年急性ST段抬高型心肌梗死(STEMI)患者左心室附壁血栓(LVT)的发生率、预测因素、治疗策略和预后情况。方法连续入选415例接受急诊介入治疗的老年STEMI患者,超声心动图检查存在LVT患者归为LVT组(36例),采用简单随机的方法从非LVT患者中抽取1∶2的患者进行配比作为非LVT组(72例)。对患者进行随访,观察治疗后LVT是否消失以及体循环栓塞发生率。结果老年STEMI患者LVT发生率为8.7%(36/415),主要为前壁38.9%(14/36)和广泛前壁心肌梗死27.8%(10/36)。LVT组患者症状发作至首份心电图(STT)时间(9.8 h比7.2 h)、SYNTAX评分(32.5分比27.4分)和术后TIMI血流<3级比例(22.2%比6.9%)显著高于非LVT组,LVT组患者左室射血分数(LVEF)(38.4%比42.8%)显著低于非LVT组(均为P<0.05)。多因素logistic回归分析证实,LVEF≤40%(OR=7.26,95%CI:2.96~20.23,P=0.02)和STT>6 h(OR=3.99,95%CI:1.83~9.62,P=0.03)是LVT形成的危险因素。结论LVT在老年STEMI患者中发生率为8.7%,体循环栓塞事件发生率为2.8%。LVEF≤40%和STT>6 h为LVT发生的独立危险因素。

Objective To investigate the incidence,predictors,treatment strategies and prognosis of left ventricular mural thrombosis(LVT)in elderly patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 415 elderly patients with STEMI undergoing emergency interventional therapy were enrolled in this study.Patients with LVT in echocardiography were classified into LVT group(36 cases).According to a 1∶2 ratio,patients from non LVT patients were selected as non LVT group(72 cases)by simple random method.The patients were followed up to observe whether LVT disappeared after treatment and calculate the incidence of systemic embolism.Results The incidence of LVT in elderly STEMI patients was 8.7%(36/415),mainly with anterior wall 38.9%(14/36)and extensive anterior wall myocardial infarction 27.8%(10/36).LVT group was associated with significantly longer symptom to first ECG time(STT)(9.8 h vs.7.2 h),higher SYNTAX score(32.5 scores vs.27.4 scores),more patients with postoperative TIMI blood flow rate<3 grade(22.2%vs.6.9%),and lower left ventricular ejection fraction(LVEF)(38.4%vs.42.8%)than non LVT group(all P<0.05).Multivariate analysis confirmed that LVEF≤40%(OR=7.26,95%CI:2.96-20.23,P=0.02)and STT>6 h(OR=3.99,95%CI:1.83-9.62,P=0.03)were risk factors for LVT.Conclusions The incidence of LVT in elderly STEMI patients is 8.7%,and the incidence rate of systemic embolism is 2.8%.LVEF≤40% and STT>6 h are independent risk factors for LVT.