摘要
目的:分析影响急性ST抬高型心肌梗死(STEMI)患者PCI术后在院期间心衰事件的危险因素。方法:连续性纳入2016年1月~2019年10月于我院行急诊PCI术的STEMI患者275例。根据患者PCI术后在院治疗期间是否发生心衰分为心力衰竭组(n=92)及对照组(n=183)。分析两组患者临床基本资料、冠状动脉血管病变情况及梗死相关血管开通时间,同时应用logistic回归分析明确影响STEMI患者PCI术后在院期间心衰事件的独立危险因素,并通过ROC曲线评估这些独立危险因素对发生心衰事件的预测价值。结果:PCI术后,STEMI患者在院期间心衰发病率为34%,单因素分析可知,与对照组相比,心衰患者年龄、cTnI、胸痛时间、肌酐水平、心肌梗死病史、多支冠脉病变比例较高,D-to-B及FMC-to-B时间较长;同时经logistic回归分析明确年龄、cTnI、心肌梗死病史及D-to-B时间是在院期间发生心衰事件的独立危险因素,其优势比(OR)(95%CI)分别为1.09(1.01~1.17)、2.20(1.22~3.99)、0.21(0.05~0.87)及1.02(1.00~1.04),同时ROC曲线表明年龄、cTnI及D-to-B时间可以作为预测心衰事件的指标,ROC曲线下面积AUC(95%CI)分别为0.79(0.70~0.88)、0.80(0.70~0.89)及0.75(0.65~0.86),三者最佳诊断界值分别为65.5岁、2.17ng/mL及107.5min。差异均具有统计学意义。结论:年龄、cTnI、心肌梗死病史及D-to-B时间是STEMI患者PCI术后在院期间发生心衰事件的独立危险因素,高龄,cTnI增高以及D-to-B时间延长增加心衰风险,同时可以作为预测在院期间心衰事件的指标。
Objective To analyze the risk factors for heart failure in ST-elevation myocardial infarction(STEMI)patients with post-PCI during hospitalization.Methods A total of 275 STEMI patients who underwent emergency primary percutaneous coronary intervention(PCI)from Jan 2016 to Oct 2019 were collected continuously.All of them were divided into heart failure(HF)group(n=93)and control group(n=183)according to whether or not HF occurred after PCI during hospitalization.The clinical characteristic,coronary vascular lesions and the time of opening infarct-related arterial were compared between HF group and control group;meanwhile,to identify the risk factors for HF by using logistic regression analysis,what’s more,the ROC curve was used to predict the value of risk factors for HF.Results In this study,the rate of HF in STEMI patients with post-PCI was 34%during hospitalization,compared with control group patients,HF group had a higher level of cTnI and Cr,older age,rate of history of MI and multiple coronary lesions and longer D-to-B time,the independent risk factors for HF during hospitalization after PCI were age,cTnI,history of MI and D-to-B and FMC-to-B time by using logistic regression analysis,the OR(95%)was 1.09(1.01~1.17),2.20(1.22~3.99),0.21(0.05~0.87)and 1.02(1.00~1.04),respectively,meanwhile,at the same time,the ROC curve showed that age,cTnI and D-to-B time used as predictors of HF,the AUC(95%CI)was 0.79(0.70~0.88),0.80(0.70~0.89)and 0.75(0.65~0.86),in addition,the best cut-off points of age,cTnI and D-to-B time was 65.5 years,2.17 ng/ml and 107.5 min,respectively.All of P values were less than 0.05.Conclusion The independent risk factors for HF in STEMI patients during hospitalization were age,cTnI,history of MI and D-to-B time,the rate of HF was increased by older age,higher cTnI concentration,and longer D-to-B time which served as prediction indicator for HF.
作者
范玲珑
户学敏
Fan Ling-long;Hu Xue-min(Suzhou First People's Hospital,Suzhou 234000,China)
出处
《湖南师范大学学报（医学版）》
2020年第4期160-164,共5页
Journal of Hunan Normal University(Medical Sciences)
作者简介
通讯作者:户学敏,E-mail:huxuemin75@163.com
