LVEF≤50％的急性冠状动脉综合征患者行经皮冠状动脉介入治疗前后微循环、心功能变化及预后影响因素分析
Analysis of changes in microcirculation,cardiac function,and prognostic factors before and after percutaneous coronary intervention in patients with acute coronary syndrome with LVEF ≤50％
鲁江斌 1王英莉 1杨登魁 2王媛媛1
作者信息
- 1. 延安大学咸阳医院超声医学科 陕西 咸阳 712000
- 2. 延安大学咸阳医院心内科 陕西 咸阳 712000
- 折叠
摘要
目的 探讨LVEF≤50％的急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)前后微循环、心功能变化及预后影响因素.方法 回顾性选取2021年1月至2023年1月延安大学咸阳医院收治的100例左室射血分数(LVEF)≤50％的ACS患者,将其分为观察组,另选取同期收治的100例LVEF＞50％的ACS患者作为对照组.两组患者均采取经皮冠状动脉介入治疗,对所有患者进行1年门诊复查随访,对比其治疗情况及随访结果.分析观察组100例ACS患者治疗前、治疗后3个月、治疗后6个月的微循环[冠状动脉微循环指数(IMR)、冠状动脉血流储备(CFR)及血小板聚集率(PAR)]及心功能[LVEF、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)]变化.将观察组患者依照其术后1年内不良心血管事件发生情况分为两个亚组,即预后良好组(n=75)及预后不良组(n=25).以预后情况作为因变量,采用多因素Logistics回归模型分析LVEF≤50％的ACS患者预后独立影响因素.结果 观察组与对照组PCI时机、血管病变数比较,差异均无统计学意义(P＞0.05).观察组围手术期病死率、不良心血管事件发生率分别为4.00％、25.00％,均高于对照组(0、13.00％),差异均有统计学意义(P＜0.05).与治疗前相比,治疗后3、6个月观察组IMR、PAR均明显降低,CFR明显升高,差异均有统计学意义(P＜0.05);但治疗后3个月与治疗后6个月的IMR、CFR、PAR相比,差异均无统计学意义(P＞0.05).与治疗前相比,观察组治疗后3、6个月LVEF明显升高,LVESV、LVEDV均明显降低,差异均有统计学意义(P＜0.05);但治疗后3个月与治疗后6个月的LVEF、LVESV、LV-EDV相比,差异均无统计学意义(P＞0.05).预后良好组与预后不良组患者心功能分级、年龄、LVEF、IMR、TIMI评分、CFR、PAR表达水平比较,差异均有统计学意义(P＜0.05).多因素Logistics回归分析结果显示,IMR、CFR、LVEF、PAR均为ACS预后不良的影响因素(P＜0.05).结论 LVEF≤50％的ACS患者通过PCI可改善其微循环及心功能,但预后水平与LVEF＞50％的ACS患者相比较差,可能受LVEF及微循环影响.
Abstract
Objective To explore the changes in microcirculation,cardiac function,and prognostic factors before and after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS)with LVEF ≤50％.Methods A total of 100 patients with ACS with left ventricular ejection fraction(LVEF)≤50％admitted to Xianyang Hospital of Yan'an University from January 2021 to January 2023 were selected as the study subjects and divided into the observation group.In addition,100 ACS patients with LVEF＞50％admitted during the same period were selected as the control group.All patients in the two groups underwent percutaneous coronary intervention treatment,and a one-year outpatient follow-up was conducted to compare their treatment status and follow-up results.The changes in microcirculation[index of microcir-culation resistance(IMR),coronary flow reserve(CFR)and platelet aggregation rate(PAR)]and cardiac function[LVEF,left ventricular systol-ic volume(LVESV),left ventricular end-diastolic volume(LVEDV)]in 100 patients with ACS in the observation group before and 3 months af-ter treatment and 6 months after treatment were analyzed.Patients in the observation group were divided into two subgroups based on the incidence of adverse cardiovascular events within one year after surgery,namely the good prognosis group(n=75)and the poor prognosis group(n=25).The prognosis was used as the dependent variable,and multivariate Logistic regression model was used to analyze the independent prognostic factors of patients with acute coronary syndrome with LVEF ≤50％.Results There were no statistically significant differences in the timing of PCI treat-ment and the number of vascular lesions between the observation group and the control group(P＞0.05).The perioperative mortality rate and in-cidence of adverse cardiovascular events in the observation group were 4.00％and 25.00％,respectively,which were higher than those in the control group(0,13.00％),and the differences were statistically significant(P＜0.05).Compared with before treatment,IMR and PAR were significantly decreased and CFR was significantly increased at 3 and 6 months after treatment in the observation group,and the differences were sta-tistically significant(P＜0.05);but there were no statistically significant differences in IMR,CFR and PAR between 3 months after treatment and 6 months after treatment(P＞0.05).Compared with before treatment,LVEF was significantly increased,LVESV and LVEDV were signifi-cantly decreased at 3 and 6 months after treatment in the observation group,the differences were statistically significant(P＜0.05);but there were no statistically significant difference in LVEF,LVESV and LVEDV between 3 months after treatment and 6 months after treatment(P＞0.05).There were statistically significant differences in cardiac function classification,age,LVEF,IMR,T1MI score,CFR and PAR expression levels between the good prognosis group and the poor prognosis group(P＜0.05).Multivariate Logistics regression analysis showed that IMR,CFR,LVEF and PAR were the influencing factors of poor prognosis of ACS(P＜0.05).Conclusion Patients with acute coronary syndrome with LVEF ≤50％can improve their microcirculation and cardiac function through percutaneous coronary intervention,but the prognosis is worse compared to patients with acute coronary syndrome with LVEF＞50％,which may be influenced by left ventricular ejection fraction and microcirculation.
关键词
急性冠状动脉综合征/微循环/预后/左室射血分数/经皮冠状动脉介入术/心功能/影响因素Key words
Acute coronary syndrome/Microcirculation/Prognosis/Left ventricular ejection fraction/Percutaneous coronary interven-tion/Heart function/Influencing factors引用本文复制引用
出版年
2024
NETL
NSTL
万方数据