急性ST段抬高型心肌梗死患者冠脉再通及其预后因素分析
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1.南京医科大学附属南京医院南京市第一医院心内科;2.响水县人民医院心内科

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南京市卫生局重点项目(ZKX16049)


Analysis of coronary recanalization and its prognostic factors in patients with acute ST-segment elevation myocardial infarction
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Department of Cardiology,Nanjing First Hospital,Nanjing Medical University

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    摘要:

    目的:探究急性ST段抬高型心肌梗死(ST-segment elevation myocardial infraction,STEMI)患者冠脉再通(Spontaneous recanalization,SR)的影响因素及其对长期预后的影响。方法:连续纳入2011年7月至2019年4月于南京市第一医院诊断为STEMI并行急诊冠脉介入治疗的患者,根据冠脉造影结果分为SR组(TIMI血流0-1级)和非SR组(TIMI血流2-3级),收集两组患者一般临床资料、实验室检查结果、冠脉造影及药物治疗数据,主要观察终点为全因死亡。结果:总计纳入1124例STEMI患者,其中包括SR组272例(24.2%),非SR组852例(75.8%)。SR组患者高血压比例、CK-MB峰值、肌酐、尿酸、血栓抽吸比例、IABP植入及院内死亡率明显低于非SR组,而左心射血分数高于非SR组。多因素Logistic回归分析显示合并高血压不利于SR发生(OR=0.744,95%CI 0.561-0.985,P=0.039)。平均随访时间为75±32月,124例患者出现全因死亡。Kaplan-Meier 曲线显示,SR组和非SR患者全因死亡没有显著差异(8.8% vs 11.7%, log-rank P=0.182)。多因素COX回归分析显示,年龄、Killip分级、肌酐、院内IABP植入、左心室射血分数、单支病变、替格瑞洛、β受体阻滞剂为STEMI患者全因死亡的独立预测因子。结论:24.2% STEMI患者急诊冠脉介入治疗前发生SR,合并高血压不利于SR发生,而长期随访显示SR并未降低STEMI患者的全因死亡。

    Abstract:

    Objective: To investigate the factors of spontaneous recanalization (SR) and its impact on long-term prognosis in patients with STEMI. Methods: The study consecutively enrolled patients diagnosed with STEMI and underwent primary percutaneous coronary intervention in Nanjing First Hospital from July 2011 to April 2019. Patients were divided into the SR group (TIMI flow grade 0-1) and the Non-SR group (TIMI flow grade 2-3) based on the results of coronary angiography. The data of the two groups were collected, including general clinical data, laboratory test results, coronary angiography and drug treatment. The primary endpoint was all-cause death. Results: 1124 patients were enrolled, including 272 patients(24.2%) in the SR group and 852 patients (75.8%)in the Non-SR group. Patients with SR had significantly lower proportions of hypertension, CK-MB peak value, creatinine levels, uric acid levels, thrombus vessel aspiration rate, IABP implantation, and in-hospital mortality compared to the non-SR group. However, The left ventricular ejection fraction was higher in the SR group than in the non-SR group. Multivariate Logistic regression analysis showed that hypertension was a disadvantage for SR.(OR=0.744,95%CI 0.561-0.985, P=0.039). The mean follow-up period is 75±32 months, during which 124 patients occurred all-cause mortality. Kaplan-Meier curves indicated that no significant difference in all-cause mortality between the SR group and the non-SR group(8.8% vs. 11.7%, log-rank P=0.182). Multivariate COX regression analysis revealed that age, Killip classification, creatinine, in-hospital IABP implantation, left ventricular ejection fraction, single-vessel disease, ticagrelor and β-blocker were independent predictors of all-cause death in STEMI patients. Conclusions: 24.2% of STEMI patients occurred SR before the primary percutaneous coronary intervention. Hypertension was found to be an unfavorable factor for SR occurrence. However, long-term follow-up revealed that SR did not reduce all-cause mortality in STEMI patients.

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  • 收稿日期:2023-03-09
  • 最后修改日期:2023-06-04
  • 录用日期:2023-10-25
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