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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2012年第2期

页码:

200-204

栏目:

临床研究

出版日期:

2012-04-25

文章信息/Info

Title:

Correlation factors for major adverse cardiac and cerebrovascular events or hemorrhage in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention

作者:

邴 森¹; 4; 李成祥¹; 郭文怡¹; 李红梅²; 高 延²; 周 宁³

(1.第四军医大学西京医院心内科，陕西 西安 710032；2.解放军323医院心内科，陕西 西安 7100543； 3.武警陕西总队医院心血管内科，陕西 西安 710054；4.西安市第二医院心内科，陕西 西安 710003)

Author(s):

BING Sen¹; 4;  LI Cheng-xiang¹;  GUO Wen-yi¹;  LI Hong-mei²;  GAO Yan²;  ZHOU Ning³

(1.Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China; 2.Department of Cardiology, PLA 323 Hospital, Xi’an 710054, Shaanxi, China; 3.Department of Cardiology, Hospital of Shaanxi Provincial Corps of Chinese People’s Armed Police Forces, Xi’an 710054, Shaanxi, China; 4.Department of Cardiology, Second Hospital of Xi’an 710003, Shaanxi, China)

关键词:

心肌梗死; 急性; ST段抬高型; 经皮冠状动脉介入; 主要不良心脑血管事件; 大出血; 相关因素

Keywords:

myocardial infaction;  acute ST-elevation;  percutaneous coronary intervention;  major adverse cardiac and cerebrovascular events;  hemorrhage;  correlation factors

分类号:

R541.4

DOI:

-

文献标识码:

A

摘要:

目的:回顾性分析急性ST段抬高型心肌梗死（STEMI）患者住院行直接冠状动脉介入治疗术(PCI)后发生主要不良心脑血管事件（MACCE）及大出血的相关因素。方法：以2008年9月～2010年8月收住的235例STEMI在12 h内行直接PCI术的患者为研究对象,分为病例组（包括MACCE及大出血）和对照组。搜集手术、药物、实验室等相关因素，包括急性梗死相关血管、术中有无慢血流和无再流发生及处理、处理前后血流分级、急性梗死相关血管球囊预扩张及支架扩张最高压力等数据，同时搜集左室射血分值、血小板计数、嗜酸性粒细胞计数、嗜碱性粒细胞计数、凝血系列、肝肾功、血脂4项、空腹血糖及心肌标志物等检测指标。采用多因素Logistic回归的方法分析上述因素与MACCE及大出血的相关性。结果：单因素分析显示病例组在急性IRA行直接支架植入术的比率、凝血酶原时间、CK方面高于对照组(P<0.05)，在年龄、急性IRA慢血流及无再流的发生率、术前术中IABP的使用率、Killip分级、并发CTO的血管数量、急性IRA预扩最高压力、FPG、Cr、CK-MB方面显著高于对照组(P<0.01)；而病例组在冠脉内替罗非班使用率、行2次PCI的比率、急性IRA支架的最高压力方面低于对照组(P<0.05)，在男性患者的比率、慢血流及无再流处理前和处理后TIMI分级、植入支架的总数量、UA、TC、LDL-C、HDL-C、左室射血分数值(LVEF)方面显著低于对照组(P<0.01)。多因素Logistic回归分析显示年龄、冠脉内注射替罗非班、LVEF值与MACCE及大出血具有相关性（P<0.05），慢血流及无再流处理后TIMI分级与MACCE及大出血具有显著相关性（P<0.01）、其中年龄呈正相关，冠脉内注射替罗非班、慢血流及无再流处理后TIMI分级及左室射血分值呈负相关。结论：高龄、慢血流及无再流处理后TIMI分级小和LVEF值低是MACCE及大出血的危险因素；冠脉内注射替罗非班是保护因素。

Abstract:

AIM:To analyze correlation factors for major adverse cardiac and cerebrovascular events (MACCE) or hemorrhage in patients with acute ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). METHODS: Two hundred and twenty-five cases of patients with STEMI in our department from September, 2008 to August 2010 were analyzed retrospectively. Patients with STEMI after PCI were divided into two groups: MACCE-hemorrhage group and non-MACCE or hemorrhage group, and the relationship between factors and MACCE-hemorrhage were analyzed by multivariate logistic regression. RESULTS: Patients in the MACCE-hemorrhage group had a higher proportion of direct stenting techniques and occurrence of slow or no-reflow and using intra-aortic balloon pump (IABP), number of all vessels with chronic total occlusion (CTO), maximum pre-expansion pressure, PT, CK, and age than in the non-MACCE or hemorrhage group (P<0.05 and P<0.01). However, patients in the MACCE-hemorrhage group had a lower proportion of tirofiban use, male patients, maximum pressure of stent expansion, TIMI class after slow or no-reflow treatment, number of all stents implanted, UA, TC, LDL-C, HDL-C, and LVEF than in the non-MACCE or hemorrhage group (P<0.05 and P<0.01). Multivariate logistic regression analysis showed that age, intracoronary use of tirofiban, and LVEF were correlative factors for MACCE-hemorrhage (P<0.05), and TIMI class after slow or no-reflow treatment was evidently a correlative factor for MACCE-hemorrhage (P<0.01). CONCLUSION: Older age, lower TIMI class after slow or no-reflow treatment and low LVEF are risk factors for MACCE-hemorrhage. Intracoronary use of tirofiban is a protective factor for MACCE-hemorrhage.

参考文献/References

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备注/Memo

备注/Memo:

收稿日期：2011-11-02.通讯作者：李成祥，副教授，主要从事冠状动脉介入手术的研究Email:lichengxiang.2007@yahoo.com.cn 作者简介：邴森，主治医师，硕士生 Email:bsdn008@163.com

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更新日期/Last Update: 2012-04-01