冠心病患者经皮冠状动脉介入术后发生恶性心律失常的影响因素

Influencing Factors of Malignant Arrhythmia After Percutaneous Coronary Intervention in Patients with Coronary Heart Disease

目的分析冠心病患者经皮冠状动脉介入(PCI)术后发生恶性心律失常的影响因素。方法选取2019年10月至2021年4月开封市人民医院收治的91例冠心病患者,均接受PCI治疗,统计术后恶性心律失常发生情况,收集患者性别、年龄、体质量指数、心功能Killip分级、合并症、心率、收缩压(SBP)、舒张压(DBP)及实验室指标[血清肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、N末端脑钠肽前体(NT-proBNP)]等资料,采用logistic多元回归方程分析冠心病患者PCI术后发生恶性心律失常的影响因素。结果91例冠心病患者PCI术后出现恶性心律失常42例,未出现恶性心律失常49例;PCI术后出现恶性心律失常患者的心功能Killip分级及cTnⅠ、CK-MB、NT-proBNP水平高于未出现恶性心律失常的患者(P<0.05);心功能Killip分级(OR=3.252,95%CI:1.455~7.267,P<0.001)高及cTnⅠ(OR=4.831,95%CI:2.163~10.792,P<0.001)、CK-MB(OR=4.189,95%CI:1.886~9.305,P<0.001)、NT-proBNP(OR=6.005,95%CI:3.157~11.424,P<0.001)水平高是冠心病患者PCI术后出现恶性心律失常的独立危险因素。结论冠心病患者PCI术后恶性心律失常的发生与心功能Killip分级、cTnⅠ、CK-MB、NT-proBNP水平等关系密切,可作为预测术后恶性心律失常的指标,有助于评估患者近期预后,对临床治疗方案的制定有一定参考价值。

Objective To analyze the influencing factors of malignant arrhythmia after percutaneous coronary intervention(PCI)in patients with coronary heart disease.Methods A total of 91 patients with coronary heart disease in Kaifeng People’s Hospital from October 2019 to April 2021 were collected,and they were treated with PCI.The incidence of postoperative malignant arrhythmias was counted,and the data of gender,age,body mass index,Killip classification of cardiac function,complications,heart rate,systolic blood pressure(SBP),diastolic blood pressure(DBP)and laboratory indexes[creatine isoenzyme(CK-MB),troponinⅠ(cTnⅠ),N-termina pro-brain natriuretic peptide(NT-proBNP)]were collected.Logistic multiple regression equation was used to analyze the influencing factors of malignant arrhythmia in patients with coronary heart disease after PCI.Results In 91 patients with coronary heart disease after PCI,42 cases occurred malignant arrhythmia,and 49 cases did not develop malignant arrhythmia.The Killip classification of cardiac function and the levels of cTnⅠ,CK-MB and NT-proBNP in patients with malignant arrhythmia after PCI were higher than those in patients without malignant arrhythmia(P<0.05).High Killip classification of cardiac function(OR=3.252,95%CI was 1.455-7.267,P<0.001)and high levels of cTnⅠ(OR=4.831,95%CI was 2.163-10.792,P<0.001),CK-MB(OR=4.189,95%CI was 1.886-9.305,P<0.001)and NT-proBNP(OR=6.005,95%CI was 3.157-11.424,P<0.001)were independent risk factors for malignant arrhythmia after PCI in patients with coronary heart disease(P<0.05).Conclusion The occurrence of malignant arrhythmia after PCI in patients with coronary heart disease is closely related to Killip classification of cardiac function,cTnⅠ,CK-MB and NT-proBNP levels.It can be used as an index to predict malignant arrhythmia after PCI,help to evaluate the short-term prognosis of patients,and have a certain reference value for the formulation of clinical treatment plan.