急性ST段抬高型心肌梗死合并心源性休克行急诊PCI术后患者预后相关性分析

Prognostic analysis of PCI-treated patients with acute ST elevation myocardial infarction complicated with cardiogenic shock

目的 分析急性ST段抬高型心肌梗死(STEMI)合并心源性休克行急诊PCI术后患者短期及远期预后相关因素。方法 收集山东大学齐鲁医院急诊科2012年6月至2016年2月因STEMI入院且行急诊PCI术的748例患者的临床资料、实验室检查等数据进行分析,并对急性心肌梗死合并心源性休克(AMICS)患者进行6年随访。主要终点事件为STEMI患者院内全因死亡及AMICS患者6年全因死亡。采用Logistic回归分析STEMI患者院内死亡独立危险因素及AMICS患者6年死亡独立危险因素,采用受试者工作者曲线(ROC)评价入院随机血糖对STEMI患者住院死亡风险的预测价值,采用限制性立方样条(RCS)分析入院随机血糖与STEMI患者住院死亡及AMICS患者6年死亡的关系。结果 采用Logistic回归分析发现年龄(OR=1.064,95%CI:1.024~1.106,P=0.002)、血糖(OR=1.191,95%CI:1.042~1.361,P=0.010)、血钙(OR=0.014,95%CI:0.003~0.080,P<0.001)是STEMI患者住院死亡的独立危险因素,ROC曲线分析提示入院随机血糖水平对STEMI患者住院死亡有较高预测价值。RCS分析显示入院血糖与STEMI患者住院死亡率呈非线性关系,当入院随机血糖大于6.15mmol/L时,随血糖升高,患者死亡率升高,而当血糖小于6.15mmol/L时,入院血糖在一定程度上是住院死亡的保护性因素。而对于AMICS患者而言,Logistic回归分析发现血糖并不是其短期住院死亡及6年死亡的独立危险因素。RCS分析血糖与AMICS患者住院死亡及6年死亡关系不显著。结论 年龄、入院随机血糖、血钙为STEMI患者住院死亡独立危险因素;入院血糖与STEMI患者住院死亡成非线性关系;血糖对STEMI患者住院死亡有预测价值。而对于AMICS患者,入院血糖对其短期及远期预后无明显预测价值。

Objective To discuss the analysis of short-term and long-term prognostic factors in patients with acute ST segment elevation myocardial infarction(STEMI)combined with cardiogenic shock(CS)undergoing emergency PCI.Methods Clinical data,laboratory examinations and other data were collected from 748 patients admitted to the Emergency Department of Qilu Hospital,Shan-dong University from June 2012 to February 2016 who underwent emergency PCI due to STEMI,and conduct a 6-year follow-up of AMICS patients.The main endpoint events were all cause death in STE-MI patients and 6 year all cause death in AMICS patients.Logistic regression analysis was used to an-alyze the independent risk factors for hospital death in STEMI patients and 6-year independent risk factors for death in AMICS patients.The predictive value of random admission blood glucose on the risk of hospitalization death in STEMI patients was evaluated using the subject worker curve(ROC).And the relationship between admission random blood glucose and hospitalization death in STEMI patients,as well as the relationship between admission random blood glucose and 6-year death in AMICS patients,was analyzed using Restricted Cubic Splines(RCS).Results Logistic regression analysis revealed that age(OR=1.064,95%CI:1.024~1.106,P=0.002),blood glucose(OR=1.191,95%CI:1.042~1.361,P=0.010),and blood calcium(OR=0.014.95%CI:0.003~0.080,P<0.001)were independent risk factors for hospitalization death in STEMI patients.ROC curve analysis showed that random admission blood glucose levels had a high predictive value for hospitalization death in STEMI patients.RCS analysis shows that there is a non-linear relationship between admission blood glucose and hospitalization mortality rate of STEMI patients.When the random admission blood glucose is greater than 6.15mmol/L.the patient mortality rate increases with the increase of blood glucose.However,when the blood glucose is less than 6.15mmol/L,admission blood glucose is to some extent a protective factor for hospitalization mortality.For AMICS patients,logistic regression analysis found that blood glucose is not an independent risk factor for short-term hospitalization death and 6-year death.RCS analysis showed no significant correlation between blood glucose levels and hospital mortality and 6-year mortality in AMICS patients.Conclusions Age,random admission blood glucose,and blood calcium are independent risk factors for hospitalization death in STEMI patients.There is a non-linear relationship between admission blood glucose and hospitalization death in STEMI patients.Blood glucose has predictive value for hospitalization death in STEMI patients.For AMICS patients,admission blood glucose has no significant predictive value for their short-term and long-term prognosis.