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王海龙,王卓众,田进伟.前降支或非前降支ST段抬高型心肌梗死患者经皮冠状动脉介入术后左心室射血分数低的危险因素及预后[J].中国动脉硬化杂志,2020,(10):833~840
前降支或非前降支ST段抬高型心肌梗死患者经皮冠状动脉介入术后左心室射血分数低的危险因素及预后
Risk factors and prognosis of low left ventricular ejection fraction after percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction with left anterior descending artery or non-left anterior descending artery as culprit artery
投稿时间:2020-06-21  修订日期:2020-07-02
DOI:
中文关键词:  ST段抬高型心肌梗死  左心室射血分数  经皮冠状动脉介入术  主要不良心脑血管事件  危险因素
英文关键词:ST-segment elevation myocardial infarction  left ventricular ejection fraction  percutaneous coronary intervention  major adverse cardiac and cerebrovascular event  risk factor
基金项目:“十三五”国家重点研发计划(2016YFC1301304);霍英东青年教师基金(171032)
作者单位E-mail
王海龙 哈尔滨医科大学附属第二医院心内科,黑龙江省哈尔滨市 150001 e-mail为877140072@qq.com,e-mail为tianjinweidr2009@163.com 
王卓众 哈尔滨医科大学附属第二医院心内科,黑龙江省哈尔滨市 150001  
田进伟 哈尔滨医科大学附属第二医院心内科,黑龙江省哈尔滨市 150001 e-mail为877140072@qq.com,e-mail为tianjinweidr2009@163.com 
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中文摘要:
      目的 探讨前降支心肌梗死组(罪犯血管为前降支或左主干)与非前降支心肌梗死组(罪犯血管为回旋支或右冠状动脉)ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后左心室射血分数(LVEF)降低的危险因素及预后。方法 连续入选2017年1月至2018年12月于哈尔滨医科大学附属第二医院重症监护室接受急诊PCI的1 246例STEMI患者,记录患者的基线资料、既往史、实验室结果、冠状动脉造影结果、主要不良心脑血管事件(MACCE)和PCI术后3天内所测得的LVEF。根据造影结果将患者分为前降支心肌梗死(MI)组和非前降支MI组,将前降支MI组、非前降支MI组分别分为LVEF低(LVEF<50%)、LVEF正常(LVEF≥50%)两个亚组。对前降支MI组、非前降支MI组进行危险因素及短期临床预后分析。结果 多因素Logistic回归分析发现在前降支MI组中年龄(OR=1.024)、胸痛时间(OR=1.122)、肌钙蛋白峰值(OR=1.001)、高敏C反应蛋白(OR=1.048)、有心肌梗死病史(OR=2.404)、病变在近端(OR=1.564)、术中需要主动脉球囊反搏(OR=3.638)是心肌梗死患者PCI术后LVEF低的危险因素。而在非前降支MI组中,入院心率(OR=1.017)、肌钙蛋白峰值(OR=1.004)、尿酸(OR=1.003)、高敏C反应蛋白(OR=1.101)、病变支数(OR=1.786)、有心肌梗死病史(OR=3.025)、术前TIMI血流0/1(OR=3.237)是心肌梗死患者PCI术后LVEF低的危险因素。在前降支MI组中,LVEF低的患者住院期间心力衰竭、心源性休克发生率高于LVEF正常的患者。而在非前降支MI组中,LVEF低的患者住院期间心力衰竭、心源性休克、恶性心律失常、死亡率明显高于LVEF正常的患者。结论 前降支MI患者PCI术后LVEF低的危险因素与非前降支MI患者PCI术后LVEF低的危险因素存在显著的不同。LVEF低的患者接受PCI治疗后短期临床预后更差,院内MACCE发生率更高。
英文摘要:
      Aim To investigate the risk factors and prognosis of decreased left ventricular ejection fraction (LVEF) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) in left anterior descending artery (LAD) myocardial infarction group (LAD MI group) (LAD or left main artery as culprit vessel) and non-LAD myocardial infarction group (non-LAD MI group) (circumflex or right coronary artery as culprit vessel). Methods 1246 STEMI patients who received emergency PCI in intensive care unit of the Second Affiliated Hospital of Harbin Medical University from January 2017 to December 2018 were selected. Baseline data, past history, laboratory results, coronary angiography results, major adverse cardiac and cerebrovascular event (MACCE) and LVEF measured within 3 days after PCI were recorded. According to the results of angiography, the patients were divided into LAD MI group and non-LAD MI group, and the two groups were separately divided into two subgroups:low LVEF (LVEF<50%) group and normal LVEF (LVEF≥50%) group. The risk factors and short-term clinical prognosis of LAD MI group and non-LAD MI group were analyzed. Results Multivariate Logistic regression analysis showed that age (OR=1.024), chest pain time (OR=1.122), troponin peak (OR=1.001), high-sensitivity C-reactive protein (hs-CRP) (OR=1.048), prior myocardial infarction (OR=2.404), proximal lesion (OR=1.564) and application of intra-aortic balloon pump (OR=3.638) were risk factors for reduced LVEF after PCI in LAD MI group. However, in non-LAD MI group, admission heart rate (OR=1.017), troponin peak (OR=1.004), uric acid (OR=1.003), hs-CRP (OR=1.101), number of disease vessels (OR=1.786), prior myocardial infarction (OR=3.025) and preoperative TIMI flow grade 0/1 (OR=3.237) were risk factors for reduced LVEF after PCI. In the LAD MI group, the incidences of heart failure and cardiogenic shock during hospitalization in patients with reduced LVEF were significantly higher than those in patients with normal LVEF. In the non-LAD MI group, the incidences of heart failure, cardiogenic shock, malignant arrhythmia and mortality rate during hospitalization in patients with reduced LVEF were significantly higher than those in patients with normal LVEF. Conclusions The risk factors of low LVEF after PCI in patients with LAD MI are significantly different from those in patients with non-LAD MI. Patients with low LVEF have worse short-term clinical prognosis and higher incidence of MACCE in hospital after PCI.
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