高危急性ST段抬高型心肌梗死患者左心室血栓发生危险的影响因素

Risk factors of left ventricular thrombosis in patients with high-risk acute ST-segment elevation myocardial infarction

目的 探讨高危急性ST段抬高型心肌梗死(STEMI)患者左心室血栓发生危险因素。方法选择2015年1月至2021年6月于邯郸市第一医院收治伴左心室室壁瘤(LVA)急性STEMI患者98例,发病后2周内经检查证实继发左心室血栓35例,分析患者的一般资料、影像学检查及治疗情况,采用多因素Logistic回归分析确定伴LVA急性STEMI患者继发左心室血栓风险独立影响因素。结果 左心室血栓组患者年龄、血红蛋白(Hb)、既往心绞痛史比例、左室射血分数(LVEF)及冠状动脉(冠脉)侧支循环建立比例均显著低于非左心室血栓组(P<0.05);左心室血栓组年龄<60岁比例、血肌酐(SCr)、合并慢性肾脏病(CKD)、合并酗酒、合并贫血、LVEF≤40%比例、术前血流TIMI分级0级比例及术后血流分级TIMI≤2级比例显著高于非左心室血栓组(P<0.05);左心室血栓组接受急诊经皮冠状动脉介入治疗(PCI)或药物溶栓比例显著低于非左心室血栓组(P<0.05)。多因素Logistic回归分析结果显示,酗酒、贫血、LVEF≤40%及术前血流TIMI分级0级均是伴LVA急性STEMI患者继发左心室血栓独立危险因素(P<0.05);心绞痛史、冠脉侧支循环建立及接受急诊PCI或药物溶栓治疗均是伴LVA急性STEMI患者继发左心室血栓独立保护因素(P<0.05)。结论 伴LVA急性STEMI患者如酗酒、贫血、LVEF≤40%及术前血流TIMI分级0级更易继发左心室血栓;而存在心绞痛史、冠脉侧支循环建立及接受急诊PCI或药物溶栓治疗者继发左心室血栓风险更低。

Objective To discuss the risk factors of left ventricular thrombosis(LVT) in patients with high-risk acute ST-segment elevation myocardial infarction(STEMI). Methods The patients(n=98) with acute STEMI complicated by left ventricular aneurysm(LVA) were chosen from the First Hospital of Handan City from Jan. 2015 to June 2021, and secondary LVT was confirmed in 35 patients within 2 weeks after acute STEMI onset. The general materials, imaging examinations and treatment were analyzed. The independent risk factors affecting secondary LVT were determined by using multi-factor Logistic regression analysis in STEMI patients complicated by LVA. Results Age, hemoglobin(HGB), percentage of angina pectoris history, left ventricular ejection fraction(LVEF) and percentage of coronary collateral circulation establishment were significantly lower in LVT group than those in non-LVT group(P<0.05). The level of serum creatinine(SCr), and percentages of age<60, chronic kidney disease(CKD), excessive drinking, anemia, LVEF≤40%, grade 0 in preoperative TIMI flow grading and grade≤2 in postoperative TIMI flow grading were significantly higher in LVT group than those in nonLVT group(P<0.05). The percentages of patients received emergency PCI or thrombolysis were significantly lower in LVT group than those in non-LVT group(P<0.05). The results of multi-factor Logistic regression analysis showed that excessive drinking, anemia, LVEF≤40%, grade 0 in preoperative TIMI flow grading and grade≤2 in postoperative TIMI flow grading were independent risk factors of secondary LVT in patients with acute STEMI complicated by LVA(P<0.05). The history of angina pectoris, collateral circulation establishment and receiving emergency PCI or thrombolysis were independent protective factor of secondary LVT in patients with acute STEMI complicated by LVA(P<0.05). Conclusion STEMI patients complicated by LVA with excessive drinking, anemia, LVEF≤40%, grade 0 in preoperative TIMI flow grading and grade≤2 in postoperative TIMI flow grading are easily complicated by secondary LVT. The risk of secondary LVT is lower in patients with history of angina pectoris, collateral circulation establishment and receiving emergency PCI or thrombolysis.