急性心肌梗死患者急诊PCI后心脏破裂的危险因素分析

Analysis of risk factors for cardiac rupture after emergency PCI in patients with acute myocardial infarction

目的分析急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入(PCI)治疗后仍发生心脏破裂(CR)的危险因素。方法回顾性分析该院2017年1月至2021年2月收治的AMI患者,将成功行急诊PCI治疗后仍然发生CR的AMI患者纳入CR组(n=27),另按照1∶2的比例选择与CR组性别、年龄、心肌梗死部位、ST段抬高型心肌梗死(STEMI)、急诊成功血运重建相匹配,且未合并CR的AMI患者作为非CR组(n=54)。收集患者的性别、年龄、合并疾病、临床指标和实验室检测指标、药物使用情况等进行分析。应用单因素及多因素logistic回归分析CR的危险因素。结果两组性别、年龄、合并疾病(原发性高血压、糖尿病、高胆固醇血症、陈旧性心肌梗死、陈旧性脑梗、肾功能不全、高尿酸血症)、心肌梗死部位比较差异无统计学意义(P>0.05);CR组的合并疾病中心房颤动发病率高于非CR组(25.9%vs.9.3%),差异有统计学意义(P<0.05)。CR组的心率、血肌酐、血尿酸、N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、PCI中无复流比例、PCI后心肌梗死溶栓试验(TIMI)血流分级3级比例明显高于非CR组,而收缩压、白蛋白、LVEF、使用β受体阻断剂和肾素-血管紧张素-醛固酮系统(RAAS)抑制剂比例低于非CR组,差异有统计学意义(P<0.05)。心房颤动为CR的独立危险因素(OR=3.06,95%CI:1.16~8.10,P<0.05)。高水平白蛋白(OR=0.93,95%CI:0.88~0.99,P<0.05)和高水平LVEF(OR=0.92,95%CI:0.86~0.99,P<0.05)为CR的独立保护因素。结论CR的发生与多因素相关,心房颤动为CR的独立危险因素,高水平白蛋白和高水平LVEF为CR的独立保护因素。

Objective To analyze the risk factors of cardiac rupture(CR)still occurrence after emergency percutaneous coronary intervention(PCI)in the patients with acute myocardial infarction(AMI).Methods The patients with AMI admitted and treated in this hospital from January 2017 to February 2021 were retrospectively analyzed.The patients with AMI who still developed CR after successful emergency PCI treatment were included in the CR group(n=27),and the patients with AMI who matched the gender,age,myocardial infarction location,acute ST-segment elevation myocardial infarction(STEMI)and successful emergency revascularization with the CR group according to the ratio of 1∶2,moreover without complicating CR served as the non-CR group(n=54).The gender,age,comorbidities,clinical indicators,laboratory indicators,drug use situation were collected for conducting the analysis.The univariate and multivariate logistic regression were used to analyze the risk factors of CR.Results There were no statistically significant differences in the gender,age,comorbidities(hypertension,diabetes,hypercholesterolemia,old myocardial infarction,old cerebral infarction,renal insufficiency,hyperuricemia)and myocardial infarction location between the two groups(P>0.05).In the comorbidities,the incidence rate of atrial fibrillation in the CR group was higher than that in the non-CR group(25.9%vs.9.3%),and the difference was statistically significant(P<0.05).The heart rate,serum creatinine,serum uric acid,N-terminal brain natriuretic peptide precursor(NT-proBNP),cardiac troponin I(cTnI),proportion of no reflow in PCI,and the proportion of blood flow grade 3 in myocardial infarction thrombolysis test(TIMI)after PCI in the CR group were significantly higher than those in the non-CR group,while the proportions of systolic blood pressure,albumin,LVEF,use ofβreceptor blockers and renin-angiotensin-aldosterone system(RAAS)inhibitors were lower than those in the non-CR group,and the differences were statistically significant(P<0.05).Atrial fibrillation was an independent risk factor for CR(OR=3.06,95%CI:1.16-8.10,P<0.05).High level of albumin(OR=0.93,95%CI:0.88-0.99,P<0.05)and high level of LVEF(OR=0.92,95%CI:0.86-0.99,P<0.05)were the independent protective factors for CR.Conclusion The occurrence of CR is correlated with multifactors,atrial fibrillation is an independent risk factor for CR,and the high levels of albumin and LVEF are the independent protective factors for CR.