基于倾向性评分匹配法评估新发CLBBB对急性STE-MI-PCI治疗患者术后远期不良心脑血管事件发生的影响

Effect of onset complete left bundle branch block on major adverse cardiovascular cerebrovascular events after percutaneous coronary intervention for ST-segment elevation myocardial infarction patients by using propensity score matching method

目的 探讨新发完全左束支传导阻滞(complete left bundle branch block,CLBBB)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后患者远期不良心脑血管事件(major adverse cardiovascular cerebrovascular events,MACCE)发生的影响。方法 2013年1月至2017年1月邯郸市第一医院心脏内科住院符合纳入标准的研究对象,依据入院18导联心电图检查评估是否新发CLBBB分为STEMI合并CLBBB组297例、对照组2 256例。通过倾向性评分匹配法平衡两组间各协变量,进行预后分析。结果 STEMI合并CLBBB组原发性高血压(高血压)、2型糖尿病、现症吸烟比例显著高于对照组,差异均有统计学意义(均P<0.05)。多因素COX风险回归模型显示,CLBBB组患者3年MACCE发生率是对照组的1.475倍(95%CI:1.123~1.937)。倾向性评分匹配法重新分组后CLBBB仍为STEMI-PCI治疗后患者MACCE发生的独立危险因素(HR=1.566,95%CI:1.080~2.272)。结论 经倾向性评分匹配法平衡各协变量后,新发CLBBB为STEMI-PCI治疗后患者MACCE发生的独立危险因素。

Objectives To investigate the effect of onset complete left bundle branch block(CLBBB)on major adverse cardiovascular cerebrovascular events(MACCE)of patients with ST-segment elevation myocardial infarction(STEMI)undergone percutaneous coronary intervention(PCI). Methods A total of 297 STEMI inpatients with CLBBB and a control group of 2 256 cases without CLBBB undergone PCI were consecutively enrolled from January 2013 for January 2017 in the division of cardiology in The First Hospital of Handan. Propensity score matching were performed for prognosis analysis. Results The prevalences of hypertension,type 2 diabetes mellitus and smoking were significantly higher in CLBBB group than in control goup(all P<0.05). The multivariate COX regression model showed that the incidence of MACCE was significantly increased 1.475 fold in CLBBB group compared with control group(P<0.05). After propensity score matching,CLBBB was still an independent risk factor of patients with STEMI undergone PCI(HR=1.566,95%CI:1.080-2.272). Conclusions After propensity score matching,CLBBB was an independent prognostic risk factor of MACCE for STEMI after PCI.