PCI术后72 h内动态BPV对STEMI患者随访MACE发生风险的影响

Influence of BPV Within 72-hour After PCI on MACE Risk During Follow-up in Patients with

目的探讨经皮冠状动脉介入(PCI)术后72 h内血压变异性(BPV)对ST段抬高型心肌梗死(STEMI)患者随访主要心血管不良事件(MACE)发生风险的影响,旨在为后续个体化防治方案制定及预后评估提供更多证据。方法回顾性纳入2017年1月-2020年6月于邯钢医院行直接PCI术治疗的STEMI患者共359例,根据术后72 h内收缩压和舒张压变异性分为高水平组和低水平组,比较各组临床特征资料及随访24个月MACE发生情况。采用Logistic回归模型评价PCI术后72 h内动态BPV对STEMI患者术后随访24个月MACE发生风险的独立影响,描绘ROC曲线评价PCI术后72 h内动态BPV用于随访MACE发生风险预测临床效能。结果收缩压变异性高水平组房颤比例、高血压比例及ACEI/ARB使用比例均高于低水平组(P<0.05);舒张压变异性高水平组高血压比例、体质量指数及ACEI/ARB使用比例均高于低水平组,但年龄和LVEF水平均低于低水平组(P<0.05);收缩压变异性高水平组心力衰竭发生率高于低水平组(P<0.05);舒张压变异性高水平组心力衰竭和MACE发生率均高于低水平组(P<0.05);Logistic回归模型多因素分析结果显示,整体人群中收缩压高变异性是心力衰竭发生独立危险因素,舒张压高变异性是心力衰竭及MACE发生独立危险因素(P<0.05);而口服降压药物人群中收缩压和舒张压高变异性均是心力衰竭及MACE发生独立危险因素(P<0.05)。ROC曲线分析结果显示,舒张压高变异性可用于STEMI患者PCI术后随访24个月MACE发生风险预测,AUC=0.863(95%CI:0.783~0.923)。结论STEMI患者随访MACE发生与PCI术后72 h内动态BPV水平关系密切,且收缩压和舒张压变异性联合在预测患者术后24个月MACE发生风险方面效能良好。

Objective To investigate the effect of blood pressure variability(BPV)within 72-hour after percutaneous coronary intervention(PCI)on the risk of major adverse cardiovascular events(MACE)in patients with ST-segment elevation myocardial infarction(STEMI)during follow-up,so as to provide more evidence for subsequent individualized prevention and prognosis evaluation.Methods A total of 359 STEMI patients who underwent primary PCI in Hangang Hospital from January 2017 to June 2020 were retrospectively included.According to the variability of systolic and diastolic blood pressure within 72-hour after operation,they were divided into high-level group and low-level group.The clinical characteristics of each group and the occurrence of MACE after 24 months of follow-up were compared.Logistic regression model was used to evaluate the independent effect of dynamic BPV within 72-hour after PCI on the risk of MACE in STEMI patients after 24 months of follow-up.The ROC curve was used to evaluate the clinical efficacy of dynamic BPV within 72-hour after PCI in predicting the risk of MACE.Results The proportion of atrial fibrillation,hypertension and ACEI/ARB used in high-level group of systolic blood pressure variability were higher than those in low-level group(P<0.05).The proportion of hypertension,body mass index and proportion of ACEI/ARB used in high-level group of diastolic blood pressure variability were higher than those in low-level group,but the age and LVEF levels were lower than those in the low-level group(P<0.05).The incidence of heart failure in high-level group of systolic blood pressure variability was higher than that in low-level group(P<0.05).The incidence of heart failure and MACE in high-level group of diastolic blood pressure variability was higher than that in low-level group(P<0.05).Multivariate analysis of Logistic regression model showed that high variability of systolic blood pressure was an independent risk factor for heart failure in the whole population,and high variability of diastolic blood pressure was an independent risk factor for heart failure and MACE(P<0.05);while,the high variability of systolic blood pressure and diastolic blood pressure in the population of oral antihypertensive drugs is an independent risk factor for heart failure and MACE(P<0.05).ROC curve analysis showed that high diastolic blood pressure variability could be used to predict the risk of MACE in STEMI patients after PCI for 24 months,AUC=0.863(95%CI:0.783-0.923).Conclusion The occurrence of MACE in STEMI patients during follow-up is closely related to the dynamic BPV level within 72-hour after PCI,and the combination of systolic blood pressure and diastolic blood pressure variability is effective in predicting the risk of MACE 24 months after PCI.