ST段抬高型心肌梗死患者直接经皮冠脉介入治疗发生再灌注损伤的预测因素分析

Analysis of predictive factors for myocardial reperfusion injury after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

目的 探讨STEMI患者直接经皮冠脉介入(primary percutaneous coronary intervention, pPCI)治疗发生心肌再灌注损伤(myocardial reperfusion injury, MRI)的影响因素。方法 回顾性连续收集2016年12月—2018年8月在郑州市第七人民医院确诊为STEMI并成功行pPCI治疗的196例患者的资料,采用t检验或卡方检验及多因素logistic回归分析筛选出STEMI患者pPCI治疗发生MRI的相关危险因素;该预测因素的辨别力采用受试者工作特征曲线(the receiver operating characteristic curve, ROC)检验,依据Hosmer-Lemeshow(H-L)检验评估该预测因素的拟合性能。结果 多因素logistic回归分析显示:缺血时间>7.75 h(OR=4.86,95%CI:2.126~11.116)、心肌下壁梗死(OR=6.59,95%CI:2.936~14.79)、多支血管病变(OR=4.192,95%CI:1.72~10.215)、入院高血糖(OR=1.197,95%CI:1.044~1.372)是STEMI患者MRI的独立危险因素,入院时较高收缩压(OR=0.952,95%CI:0.933~0.972)、心梗发作前心绞痛(OR=0.302,95%CI:0.129~0.703)是MRI的保护性因子。结论 缺血时间较长、下壁心肌梗死、多支血管病变、入院高血糖增加STEMI患者pPCI治疗MRI的发生风险,而入院时较高收缩压和心梗发作前心绞痛的发生是MRI的保护性因素。

Objective To explore the predictive factors for the occurrence of myocardial reperfusion injury during primary percutaneous coronary intervention(pPCI)for ST-segment elevation myocardial infarction(STEMI).Methods Totally 196 patients with STEMI following pPCI admitted from Dec.2016 to Aug.2018 in the 7 th People’s Hospital of Zhengzhou were enrolled in the study.The clinical and angiographic data were analyzed by t test Chi-square test and multivariate logistic regression to screen the independent predictive factors for STEMI patients treated with pPCI.The discrimination of predictive factors was based on the receiver operating characteristic curve(ROC) to test, and the fitting performance of the predictive factors was evaluated according to the Hosmer-Lemeshow(H-L) test.Results Multivariate logistic regression analysis showed that 6 variables for MRI were independent predictive factors including the time intervals from angina attack to IRA reflow ≥7.75 hours(OR=4.86,95%CI: 2.126-11.116 P=0.000),inferior infarction location(OR=6.59,95%CI: 2.936-14.79 P=0.000),multivessel lesions(OR=4.192,95%CI:1.72-10.215 P=0.0002),which is higher than that of admission diastolic blood pressure(OR=0.952,95%CI:0.933-0.972,P=0.000),admission hyperglycemia(OR=1.197,95%CI:1.044-1.372,P=0.010),Pre-infarction angina(OR=0.302,95%CI:0.129-0.703,P=0.006).Conclusion Long time interval from angina attack to IRA revascularization, inferior wall infarction location, multivessel lesions and admission hyperglycemia may promote the occurrence of MRI after pPCI,whereas higher admission systolic blood pressure, pre-infarction angina maybe cardio-protective factors for MRI.