急性心肌梗死经皮冠状动脉介入治疗术后室壁瘤患者发生左心室血栓的相关因素研究

Related factors of thrombosis on left ventricular aneurysm in patients with acute myocardial infarction after PCI

目的探讨急性心肌梗死经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后室壁瘤患者发生左心室血栓(left ventricular thrombus,LVT)的相关因素。方法回顾性分析吉林大学中日联谊医院166例急性心肌梗死经PCI术后3个月内并发室壁瘤患者的临床资料,根据是否发生LVT分为LVT组(26例)和非LVT组(140例),分析两组患者的一般资料,并对可能导致左心室血栓发生的危险因素进行单因素分析,将差异有统计学意义的指标进行多因素Logistic回归分析,研究造成LVT的高危因素。结果单因素分析结果显示,LVT组前壁心肌梗死比例高于非LVT组(P<0.05),白细胞水平低于非LVT组(P<0.05)。经胸心脏超声结果显示,LVT组左室内径及左室后壁厚度均大于非LVT组(P<0.05)。多因素Logistic回归分析结果显示,前壁心肌梗死(β=1.595,OR=4.930,95%CI:1.080~22.503)是急性心肌梗死PCI术后室壁瘤患者发生LVT的独立危险因素(P<0.05)。结论前壁心肌梗死是急性心肌梗死PCI术后室壁瘤患者发生LVT的独立危险因素。

Objective To explore the related factors of thrombosis on left ventricular aneurysm in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods 166 acute myocardial infarction patients who underwent PCI with ventricular aneurysm within three months were retrospective enrolled.The patients were divided into thrombus group and non-thrombus group according to whether left ventricular thrombosis occurred,while 26 cases in the thrombus group and 140 cases in the non-thrombus group.The general clinical data was analyzed in both groups.Univariate regression analysis was used to explore the risk factors of left ventricular thrombosis and the factors with significant difference were conducted to multifactorial logistic regression analysis to confirm the independent risk factors.Results Univariate analysis showed that the proportion of myocardial infarction on anterior wall was significantly higher in the left ventricular thrombus(LVT)group than in the non-LVT group(P<0.05),and the leukocyte level was lower in LVT group than in the non-LVT group(P<0.05).Transthoracic echocardiography showed that the left ventricular end diastolic diameter and posterior wall thickness were significantly higher in the LVT group than in the non-LVT group(P<0.05).Multivariate logistic regression analysis showed that anterior wall myocardial infarction(β=1.595,OR=4.930,95%CI:1.080~22.503)was an independent risk factor for the development of LVT in AMI patients with ventricular aneurysm after PCI(P<0.05).Conclusions Anterior wall myocardial infarction is an independent risk factor for the development of LVT in AMI patients with ventricular aneurysm after PCI.