实用老年医学

实用老年医学 ›› 2021, Vol. 35 ›› Issue (9): 918-922.doi: 10.3969/j.issn.1003-9198.2021.09.007

• 临床研究 • 上一篇    下一篇

老年急性前壁心肌梗死病人冠状动脉介入治疗后左心室收缩功能障碍的预测因子分析

梁景康, 郭军   

  1. 510630 广东省广州市,暨南大学附属第一医院心血管内科
  • 收稿日期:2020-10-19 发布日期:2021-09-13
  • 通讯作者: 郭军,Email:dr.guojun@163.com
  • 基金资助:
    广州市天河区科技计划项目(医疗卫生专项)(2018YT013)

Predictive factors of left ventricular systolic dysfunction in elderly patients with acute anterior myocardial infarction after percutaneous coronary intervention

LIANG Jing-kang, GUO Jun   

  1. Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
  • Received:2020-10-19 Published:2021-09-13

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摘要： 目的 探讨老年急性前壁ST段抬高型心肌梗死(STEMI)病人经皮冠状动脉介入治疗(PCI)后左心室收缩功能障碍(LVSD)的预测因子。 方法 连续纳入2013年1月至2019年9月在暨南大学附属第一医院确诊为急性前壁STEMI并行直接PCI的374例老年病人,根据PCI术后至出院前心脏彩超测得的LVEF最低值分为LVSD组(LVEF≤40%,n=120)及对照组(LVEF＞40%,n=254)。比较2组病人的基线资料、实验室检查结果、心脏彩超及冠脉造影等检查结果,采用多因素Logistic回归分析老年急性前壁STEMI发生LVSD的预测因子。结果 本组老年急性前壁STEMI病人PCI术后LVSD的发生率为32.09%(120/374)。多因素Logistic回归分析显示,术前罪犯血管心肌梗死溶栓试验(TIMI)血流分级≤1级(OR=2.738,95%CI:1.516~4.943,P=0.001)、入院心率(OR=1.028,95%CI:1.012~1.045,P=0.001)、入院SBP(OR=0.985,95%CI:0.974~0.996,P=0.006)、左心室舒张末期内径(OR=1.132,95%CI:1.074~1.192,P＜0.001)、左主干病变(OR=2.571,95%CI:1.106~5.974,P=0.028)、N末端B型利钠肽原(NT-proBNP)峰值(OR=1.095,95%CI:1.055~1.137,P＜0.001)是老年急性前壁STEMI病人PCI术后LVSD的独立预测因子。 结论 术前罪犯血管TIMI血流分级≤1级、入院心率、入院SBP、左心室舒张末期内径、左主干病变、NT-proBNP峰值是老年急性前壁STEMI病人PCI术后LVSD的独立预测因子。

关键词: 心肌梗死, 经皮冠状动脉介入治疗, 左心室收缩功能障碍, 预测因子, 老年人

Abstract: Objective To investigate the predictors of left ventricular systolic dysfunction (LVSD) in the elderly patients with acute anterior ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods A total of 374 elderly patients with acute anterior STEMI who underwent primary PCI in the First Affiliated Hospital of Jinan University from January 2013 to September 2019 were divided into LVSD group [left ventricular ejection fraction (LVEF)≤40%, n=120] and control group (LVEF>40%, n=254) according to the lowest LVEF measured by color Doppler echocardiography from post-PCI to discharge. The clinical data, biochemical results, echocardiographic and angiographic data of the two groups were compared. Multivariate Logistic regression analysis was performed to evaluate the independent predictors of LVSD. Results The incidence rate of LVSD in the elderly patients with acute anterior STEMI after PCI was 32.09%(120/374). Multivariate Logistic regression analysis showed that the criminal vessel thrombolysis in myocardial infarction (TIMI) flow grade≤1(OR=2.738, 95%CI:1.516-4.943, P=0.001),admission heart rate (OR=1.028, 95%CI:1.012-1.045, P=0.001), admission systolic blood pressure (OR=0.985,95%CI: 0.976-0.996,P=0.006), left ventricular end-diastolic diameter (OR=1.132,95%CI:1.074-1.192, P<0.001), left main coronary artery lesion (OR=2.571, 95%CI: 1.106-5.974,P=0.028), peak level of N-terminal B-type natriuretic peptide (OR=1.095,95%CI:1.055-1.137, P<0.001) were independent predictors of LVSD in the elderly patients with acute anterior STEMI after PCI. Conclusions Criminal vessel TIMI flow grade≤1, admission heart rate, admission systolic blood pressure, left ventricular end-diastolic diameter, left main coronary artery lesion and peak level of N-terminal B-type natriuretic peptide are independently associated with LVSD in the elderly patients with acute anterior STEMI after PCI.

Key words: myocardial infarction, percutaneous coronary intervention, left ventricular systolic dysfunction, predictor, aged

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