老年ST段抬高型心肌梗死合并睡眠呼吸暂停综合征对介入术后心肌组织灌注的影响

Effect of obstructive sleep apnea syndrome on myocardial perfusion in elderly patients with STEMI after PCI

目的分析阻塞性睡眠呼吸暂停综合征(OSAS)对老年ST段抬高型心肌梗死(STEMI)患者急诊PCI后心肌组织灌注的影响。方法回顾性分析2019年1月~2020年12月首都医科大学附属北京世纪坛医院心内科和首都医科大学附属北京安贞医院心内科行急诊PCI的老年STEMI合并OSAS患者382例,根据呼吸暂停低通气指数(AHI)分为轻度组172例、中度组133例和重度组77例,观察3组基线资料,用TIMI心肌灌注(TMP)分级和TIMI血流分级评估心肌组织灌注。结果重度组年龄、糖尿病、高血压、空腹血糖、多支血管病变比例明显高于轻度组和中度组,梗死动脉术中开通时间明显长于中度组和轻度组,高脂血症比例和LDL-C水平明显高于轻度组(P<0.05)。重度组术后TIMI 3级和TMP 3级比例明显低于轻度组和中度组(79.2%vs 90.7%、92.5%,70.1%vs 84.9%、87.2%,P<0.05)。AHI≥30次/h是影响术后TIMI血流0~2级的危险因素(95%CI:1.233~7.506,P=0.015)。结论老年STEMI患者的AHI值是影响其急诊PCI术后心肌组织血流灌注复流情况的危险因素,即伴重度OSAS的老年STEMI患者预后不良。

Objective To analyze the effect of OSAS on myocardial perfusion in the elderly patients with STEMI after emergency PCI.Methods The clinical data of 382 OSAS patients undergoing emergency PCI due to STEMI in cardiological departments of Beijing Shijitan Hospital and Beijing Anzhen Hospital from January 2019 to December 2020 were collected and analyzed retrospectively.According to their AHI,the patients were divided into mild(n=172),moderate(n=133)and severe(n=77)groups.The baseline data were collected.TMP grading and TIMI flow grading systems were used to assess the myocardial perfusion level after PCI.Results The severe group had older age,higher fasting blood glucose,and larger proportions of DM,hypertension and multi-vessel disease,and obviously longer time for recanalization during PCI when compared with the moderate and mild groups,but its LDL-C level and proportion of hyperlipidemia were only higher than the mild group(P<0.05).After emergency PCI,the severe group got lower percentages of patients with TIMI grade 3 and TMP grade 3 than the mild group and the moderate group(79.2%vs 90.7%,92.5%;70.1%vs 84.9%,87.2%;P<0.05).AHI≥30 times/h was a risk factor for TIMI grade 0~2(95%CI:1.233-7.506,P=0.015).Conclusion AHI is risk factor for myocardial perfusion in elderly STEMI patients after emergency PCI.That is,when STEMI occurs in the elderly with severe OSAS,the prognosis is poor.