ST段抬高型心肌梗死患者术后近远期死亡风险因素及与慢性闭塞病变的关系

Short-term and Long-term Risk Factors of Death in Patients with ST-segment Elevation Myocardial Infarction after Operation and Its Relationship with Chronic Total Occlusion

目的探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者术后近远期死亡危险因素及与慢性完全闭塞(chronic total occlusion,CTO)病变的关系。方法本研究回顾性纳入2017年1月至2020年6月于运城市中心医院行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的STEMI患者共357例的临床资料,根据冠状造影结果是否存在CTO分为CTO组和非CTO组。分析两组患者一般资料、超声心动图指标、实验室检查指标及预后资料,采用Logistic回归模型评价STEMI患者术后近远期死亡独立危险因素。结果CTO组和非CTO组患者的心肌梗死病史比例、接受冠状动脉旁路移植术(coronary artery bypass grafting,CABG)治疗比例、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)比较,差异有统计学意义(P<0.05)。CTO组患者住院期间全因病死率、心源性病死率、心力衰竭发生率及总主要不良心血管事件(major adverse cardiovascular event,MACE)发生率均显著高于非CTO组,差异有统计学意义(P<0.05);CTO组患者术后1年全因病死率、心源性病死率、心力衰竭发生率、再次血运重建率及总MACE发生率均显著高于非CTO组,差异有统计学意义(P<0.05)。多因素分析结果显示,高龄、低LVEF及近4周内吸烟是STEMI患者住院期间死亡独立危险因素(P<0.05);合并CTO、高龄、心力衰竭病史及低LVEF是STEMI患者术后1年死亡独立危险因素(P<0.05)。结论STEMI患者预后与多种因素有关,包括年龄、低LVEF、近4周内吸烟情况、是否合并CTO或心力衰竭病史,其中合并CTO者术后1年内死亡风险往往较高。

Objectives To investigate the short-term and long-term risk factors of death in patients with ST-segment elevation myocardial infarction(STEMI)after operation and its relationship with chronic total occlusion(CTO).Methods Clinical characteristic of totally 357 STEMI patients with emergency percutaneous coronary intervention(PCI)were retrospectively chosen in the period from January 2017 to June 2020 in Yuncheng Central Hospital.All the patients were grouped into CTO group and non-CTO group according to the CTO results by coronary angiography.The general data,cardiac ultrasound indexes,laboratory examination indexes and prognosis were analyzed and Logistic regression model was used to evaluate the independent risk factors of death in patients with STEMI during hospitalization and postoperative follow-up.Results There were significant differences in the proportion of myocardial infarction history,the proportion of performing coronary artery bypass grafting(CABG)treatment,left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)between CTO group and nonCTO group(P<0.05).The all-cause mortality,cardiogenic mortality,the incidence of heart failure and the incidence of total major adverse cardiovascular event(MACE)in CTO group were significantly higher than nonCTO group(P<0.05).Oneyear postoperative allcause mortality,cardiogenic mortality,the incidence of heart failure,the revascularization rate and the incidence of MACE were significantly higher than those in nonCTO group.Multivariate analysis showed that old age,low LVEF and smoking in recent 4 weeks were independent risk factors of death in STEMI patients(P<0.05).CTO,older age,history of heart failure and low LVEF were independent risk factors of 1-year mortality in patients with STEMI(P<0.05).Conclusions Older age,low LVEF,smoking in recent 4 weeks,CTO and history of heart failure in STEMI patients have poor prognosis and patients with CTO could be more likely to die within 1 year after PCI.