急性心肌梗死死亡及再梗死相关因素的分析

Analysis of factors correlated to death and reinfarction in patients with acute myocardial infarction

目的 :确定尿激酶 (UK )溶栓治疗和经皮冠状动脉腔内成形术 (PTCA)治疗的急性心肌梗死 (AMI)患者住院期和随访期死亡和再发心肌梗死 (心梗 )的预测因素。方法 :采用双向性队列研究 ,观察 190例 AMI患者住院期和随访期的临床结果。将死亡和再发心梗合并为恶性事件 ,应用 Spearm an等级相关法分析及多变量L ogist回归分析方法确定住院期和随访期恶性事件的相关因素及独立预测因素。结果 :住院期恶性事件发生率UK组为 15 .4 6 % ,PTCA组为 6 .4 5 % ;随访 (13.81± 7.39)月累计的恶性事件发生率 U K组为 30 .93% ,PTCA组为 9.6 8%。与 U K组和 PTCA组住院和随访期恶性事件发生呈正相关的因素包括 :年龄、Q波导联数、Killip分级、住院期心力衰竭 (心衰 )、既往高血压病史、心梗史等 ;呈负相关的因素是 :吸烟史、收缩压、住院期射血分数值等。介入治疗是两组患者住院期和随访期恶性事件的独立预测因子 ,也是介入治疗组患者恶性事件惟一的独立预测因子 ,能降低恶性事件的发生率。 U K组住院期恶性事件发生的独立预测因子还有增龄、住院期心衰和 Q波导联数 ;随访期恶性事件的独立预测因子还有增龄、住院期心衰。梗死前心绞痛与心梗住院期恶性事件发生呈负相关 ;溶栓治疗与补救性 PTCA组患者住院期恶性事件发生?

Objective: To identify the predictors of death and reinfarction in patients with acute myocardial infarction (AMI) treated with urokinase (UK) thrombolysis or percutaneous transluminal coronary angioplasty (PTCA). Methods: In ambispective cohort study, 97 cases of AMI were treated with UK thrombolytic therapy, while 93 cases of AMI were treated with PTCA. The patients' data about clinical outcome during hospital and followup periods were collected. Death and reinfarction were defined as adverse event. To analyze the correlative factors and independent predictors of death and reinfarction, the spearman rank correlation and multivariate logistic regression modeling were performed. Results: During hospital, incidences of adverse event were 15 46 percent and 6 45 percent in UK and PTCA groups respectively. In followup period, they were 30 93 percent and 9 68 percent respectively. Age, Q wave leads, Killip class, heart failure in hospital, the history of hypertension and myocardial infarction were positive correlation with adverse event, whereas history of smoking, systolic blood pressure and ejection fraction(EF) showed negative correlation with the adverse event. The interventional therapy, associated with lower mortality and reinfarction rate, was the independent predictor for adverse event in UK and PTCA groups during hospital and followup periods. Furthermore , it was the only independent predictor for PTCA group. In UK group, the adverse event also was independently predicted by age, heart failure and Q wave leads in hospital and by age, heart failure during followup period. There was negative correlation between preinfarction angina and adverse event, and positive correlation between thrombolysis and adverse event in patients undergone rescue PTCA. Conclusion: Interventional therapy is crucial independent predictor for adverse event of patients suffering from AMI. The adverse event is also predicted by age, Q wave leads and heart failure. The history of preinfarction angina is negative correlation with the adverse event in hospital, due to, maybe, myocardium ischemia preconditioning.