双联抗血小板治疗在急性心肌梗死PCI术后应用的效果及预后的影响因素分析

Analysis on effect of dual antiplatelet therapy after PCI for acute myocardial infarction and influencing factors of prognosis

目的探讨急性心肌梗死(AMI)经皮冠脉介入治疗(PCI)术后应用双联抗血小板治疗(DAPT)的效果,并分析预后的影响因素。方法选取2021年6月至2022年5月于北京市健宫医院心内科行PCI术的103例AMI患者作为研究对象,均给予DAPT,统计其血小板情况,并对患者预后进行单因素分析与logistic多因素回归分析。结果治疗后血小板计数(PLT)及血小板聚集率(PAG)低于治疗前(P<0.05),PCI术后1年内共有40例(38.83%)发生不良事件,其中出血11例(10.68%)、支架内狭窄(ISR)17例(16.50%)、血管内皮增生9例(8.74%)、再次植入支架3例(2.91%);预后不良组年龄≥60岁、体重指数(BMI)>24 kg/m^(2)、多支病变血管、合并糖尿病、合并高血压、吸烟史、DAPT<1年占比高于预后良好组,差异有统计学意义(P<0.05);logistic多因素分析结果显示,年龄≥60岁(OR=1.921)、BMI>24 kg/m^(2)(OR=2.495)、多支病变血管(OR=3.743)、合并糖尿病(OR=2.162)、合并高血压(OR=2.037)、吸烟史(OR=3.259)、DAPT<1年(OR=2.756)是AMI患者PCI术后应用DAPT预后的独立影响因素(P<0.05)。结论AMI患者PCI术后应用DAPT在改善血小板情况方面效果较好,但易发生不良预后,这与年龄、BMI、病变血管支数、合并糖尿病、合并高血压、吸烟史、DAPT时间等因素相关。

Objective To explore the effect of dual antiplatelet therapy(DAPT)after percutaneous coronary intervention(PCI)for acute myocardial infarction(AMI),and to analyze the influencing factors of prognosis.Methods A total of 103 AMI patients who underwent PCI in the Department of Cardiology,Beijing Jiangong Hospital from June 2021 to May 2022 were selected as the research objects,and were given DAPT.The platelet status was counted,and the prognosis of the patients was analyzed by univariate analysis and logistic multivariate regression analysis.Results The platelet count(PLT)and platelet aggregation rate(PAG)after treatment were lower than those before treatment(P<0.05).There were 40(38.83%)adverse events within one year after PCI,including 11 events of bleeding(10.68%),17 events of in-stent restenosis(ISR)(16.50%),9 events of vascular endothelial hyperplasia(8.74%)and 3 events of stent reimplantation(2.91%).The proportions of patients with age≥60 years,body mass index(BMI)>24 kg/m^(2),multivessel disease,combined diabetes,combined hypertension,smoking history and DAPT<1 year in the poor prognosis group were higher than those in the good prognosis group,with statistically significant differences(P<0.05).Logistic multivariate analysis showed that age≥60 years(OR=1.921),BMI>24 kg/m^(2)(OR=2.495),multivessel disease(OR=3.743),combined diabetes(OR=2.162),combined hypertension(OR=2.037),smoking history(OR=3.259),and DAPT<1 year(OR=2.756)were independent influencing factors of prognosis of DAPT after PCI in AMI patients(P<0.05).Conclusion The application of DAPT after PCI in AMI patients has a good effect in improving platelet condition,but it is prone to poor prognosis,which are related to age,BMI,number of diseased vessels,combined diabetes,combined hypertension,smoking history,DAPT time and other factors.