摘要
目的:研究急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入治疗(percuta-neous coronary intervention,PCI)术后发生主要不良心血管事件(major adverse cardiovascular events,MACE)的相关因素分析.方法:回顾性分析2012年12月-2020年12月2 154例行PCI术的AMI患者临床资料.根据术后发生MACE的情况分为MACE组410例、无MACE组1 744例.比较两组的一般资料、实验室查血指标、心功能指标.结果:MACE组的男性、随访时间均显著低于无MACE组,年龄、心率、脉搏、Killip分级、糖尿病、冠心病、心绞痛、心衰、出院后β受体阻滞剂治疗、外周动脉疾病、死亡均显著高于无MACE组,差异均有统计学意义(P＜0.05).MACE组的糖化血红蛋白、即刻血糖、尿素、肌酐、钠均显著高于无MACE组,总蛋白、白蛋白、总胆红素、钙、钾、总胆固醇、低密度脂蛋白胆固醇、超敏-C反应蛋白、红细胞、红细胞压积、血红蛋白均显著低于无MACE组,差异均有统计学意义(P＜0.05).MACE组的左心室舒张末期内径、左心室收缩末期内径、舒张末期容积、收缩末期容积均显著高于无MACE组,左室射血分数显著低于无MACE组,差异均有统计学意义(P＜0.05).经多因素Cox回归分析,Killip分级(1)、外周动脉疾病、尿素、红细胞压积、血红蛋白均是MACE发生的独立危险因素(P＜0.05).随访时间的延长,患者的MACE发生率、生存率均下降.结论:心功能、外周动脉疾病、尿素、红细胞压积、血红蛋白水平均是MACE发生的独立危险因素,临床可据此对行PCI术的AMI患者进行针对性干预.
Abstract
Objective:To investigate the factors associated with the occurrence of major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)and their predictive value for patient mortality.Methods:A retrospective analysis was conducted on the clinical da-ta of 2 154 AMI patients who underwent PCI from December 2012 to December 2020.Patients were divided into the MACE group(410 cases)and the non-MACE group(1 744 cases)based on whether MACE occurred after sur-gery.The general data,laboratory blood test indicators,and heart function indicators of the two groups were compared.Results:In the MACE group,male proportion and follow-up duration were significantly lower,while age,heart rate,pulse,Killip classification,diabetes,coronary artery disease,angina,heart failure,post-dis-charge Betaloc treatment,peripheral artery disease,and mortality were all significantly higher,compared to those in the non-MACE group,with statistically significant differences(P＜0.05).In the MACE group,HbA1c,im-mediate blood glucose,urea,creatinine,and sodium levels were significantly higher,while total protein,albu-min,total bilirubin,calcium,potassium,total cholesterol,low-density lipoprotein cholesterol,high-sensitivity C-reactive protein,red blood cell count,hematocrit,and hemoglobin were significantly lower,compared to those in the non-MACE group,with statistically significant differences(P＜0.05).Also,in the MACE group end-diastolic dimension,end-systolic dimension,end-diastolic volume and end-systolic volume,were significantly higher,while ejection fraction was significantly lower compared to the non-MACE group,with statistically significant differ-ences(P＜0.05).Multivariate Cox regression analysis indicated that Killip classification(1),peripheral artery dis-ease,urea,hematocrit,and hemoglobin were independent risk factors for the occurrence of MACE(P＜0.05).With the extending of the follow-up duration,the incidence of MACE and survival rate both decreased.Conclu-sion:Cardiac function,peripheral artery disease,urea,hematocrit,and hemoglobin levels are independent risk factors for the occurrence of MACE.Targeted interventions can be made accordingly for AMI patients undergoing PCI in clinical practice.
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