左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响

The prognostic importance of left ventricular systolic function in patients with acute inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

目的探讨左心室收缩功能对经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的急性下壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者预后的影响。方法对161例PCI治疗的急性下壁STEMI患者按左心室收缩功能分为2组:左心室收缩功能障碍[左心室射血分数(left ventricular ejection fraction,LVEF)<50%]组和左心室收缩功能正常(LVEF≥50%)组。本研究的主要终点主要不良心脏事件(major adverse cardiac events,MACE)包括所有全因死亡、再发性心肌梗死、缺血驱动的血管血运重建和卒中。结果两组患者在年龄、性别、病史、Killip分级以及症状发作时间方面比较,差异均无统计学意义(P>0.05);左心室收缩功能障碍组具有更高的病变血管支数和血栓负荷(P<0.05),其他冠状动脉造影结果和介入治疗特征,两组间差异均无统计学意义(P>0.05)。两组在1年预期MACE发生率方面比较,差异均无统计学意义(Log-rank P>0.05)。结论在接受直接PCI治疗的急性下壁STEMI患者中,左心室收缩功能障碍的患者与左心室收缩功能正常的患者具有相似的1年临床不良事件发生率。

Objective To study the impact of left ventricular(LV)systolic function on outcomes of patients with acute inferior ST-segment elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods Left ventricular ejection fraction(LVEF)was determined in 161 acute inferior STEMI patients undergoing PCI,who were divided into two groups according to LV systolic function:(1)LV systolic dysfunction group(LVEF<50%);(2)normal LV systolic function group(LVEF≥50%).Study primary endpoints included major adverse cardiac events(MACE)defined as the composite of cardiac death,myocardial infarction,and ischemia-driven revascularization,and stroke.Results There was no significant difference in age,gender,medical history,Killip grade and time of symptom onset between the two groups(P>0.05).The average number of disease vessels and thrombus burden were higher in LV systolic dysfunction group(P<0.05),other baseline angiographic and procedural characteristics in this study were similar between the two groups(P>0.05).During the 1-year follow-up,the incidence of MACE was similar between the two groups in this study(Log-rank P>0.05).Conclusion Among patients with acute inferior STEMI undergoing PCI,the incidence of clinical adverse events in patients with LV systolic dysfunction was similar to that in patients with normal LV systolic function during 1-year follow-up.