老年急性冠脉综合征患者PCI术后发生心力衰竭的影响因素

Influencing Factors of Heart Failure in Elderly Patients with Acute Coronary Syndrome After PCI

目的探讨老年急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后发生心力衰竭的影响因素,为临床早期制定预防性干预措施,降低老年ACS患者PCI术后发生心力衰竭风险提供参考依据。方法选取南阳市中心医院2019年1月至2023年1月收治的行PCI术治疗的350例老年ACS患者。PCI术后随访6个月,根据是否发生心力衰竭将350例老年ACS患者分为无心衰组和心衰组。收集并比较无心衰组和心衰组患者的临床资料;二元logistic回归分析老年ACS患者PCI术后发生心力衰竭的影响因素。结果PCI术治疗6个月后,350例老年ACS患者中发生心力衰竭73例,心力衰竭发生率为20.86%。两组年龄、心功能分级、冠脉狭窄程度、冠脉病变支数、合并心律失常、血清N末端前脑利钠肽(NT-proBNP)、D-二聚体(D-D)、血尿酸(SUA)水平、左心室射血分数(LVEF)比较,差异有统计学意义(P<0.05)。二元logistic回归分析结果显示,年龄大、心功能分级≥Ⅲ级、冠脉重度狭窄、冠脉多支病变支数、合并心律失常、血清NT-proBNP、D-D、SUA水平升高、LVEF下降是老年ACS患者PCI术后发生心力衰竭的独立危险因素。结论临床上应针对上述老年ACS患者PCI术后发生心力衰竭的相关危险因素,制定预防性干预措施,以降低老年ACS患者PCI术后发生心力衰竭的风险,改善老年ACS患者的预后。

Objective To investigate the influencing factors of heart failure in elderly patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI),and to provide a reference for formulating preventive intervention measures in early clinical stage and reducing the risk of heart failure in elderly patients with ACS after PCI.Methods A total of 350 elderly ACS patients admitted to Nanyang Central Hospital from January 2019 to January 2023 who underwent PCI were selected.They were divided into no-heart failure group and heart failure group according to whether heart failure occurred after 6 months of PCI.The clinical data were collected and compared between no-heart failure group and heart failure group.Binary Logistic regression was used to analyze the influencing factors of heart failure in elderly ACS patients after PCI.Results After 6 months of PCI,73 cases occurred heart failure in 350 elderly patients with ACS,the incidence of heart failure was 20.86%.There were differences in age,cardiac function grade,degree of coronary stenosis,number of coronary lesions,complicated arrhythmia,serum N-terminal pro brain natriuretic peptide(NT-proBNP),D-dimer(D-D),serum uric acid(SUA)level and ultrasound index left ventricular ejection fraction(LVEF)between the heart failure group and the non-heart failure group(P<0.05).Binary logistic regression analysis showed that older age,heart function grade≥Ⅲ,severe coronary stenosis,number of coronary multi-vessel lesions,complicated arrhythmia,higher serum levels of NT-proBNP,D-D,SUA,and decreased LVEF were independent risk factors of heart failure in elderly ACS patients after PCI.Conclusion Preventive intervention measures should be developed according to the above risk factors of heart failure in elderly patients with ACS after PCI,so as to reduce the risk of heart failure and improve the prognosis of elderly patients with ACS.