左室舒张末压联合踝臂指数对急性心肌梗死经皮冠状动脉介入治疗无复流及预后的预测价值

doi:10.3969/j.issn.1003-9198.2022.03.011

摘要/Abstract

摘要： 目的探讨左室舒张末压(LVEDP)联合踝臂指数(ABI)对急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)无复流及预后的预测价值。方法将我院2017～2018年收治的280例AMI病人作为研究对象,均行PCI治疗,根据术中复流发生情况分为正常组、无复流组。比较2组病人的临床资料、LVEDP、ABI等,采用Logistic 回归分析无复流发生的危险因素。PCI术后随访1年,记录主要不良心血管事件(MACE),比较2组病人MACE发生情况,采用ROC曲线分析LVEDP联合ABI对预后的预测价值。结果无复流组病人的LVEDP、Killip分级为Ⅲ~Ⅳ级人数占比、肌酸激酶同工酶峰值、BNP水平均明显高于正常组(P<0.05),LVEF、ABI明显低于正常组(P<0.01)。Logistic回归分析显示,心功能Killip分级、LVEDP、ABI、BNP水平是AMI病人PCI术中发生无复流的独立危险因素(P<0.05)。随访1年,正常组全因死亡率(4.33% 比 11.11%)以及总MACE发生率(16.83 % 比 34.72%)明显低于无复流组,差异有统计学意义(P<0.05)。LVEDP和ABI联合预测MACE的AUC为0.875(95%CI:0.819~0.931),明显高于LVEDP、ABI单独预测(P<0.05)。结论 LVEDP和ABI是AMI病人PCI术中发生无复流的独立危险因素,两者联合检测对于病人预后预测具有潜在应用价值。

关键词: 左室舒张末压, 踝臂指数, 急性心肌梗死, 无复流, 预后

Abstract: Objective To explore the predictive value of left ventricular end diastolic pressure (LVEDP) combined with ankle-brachial index (ABI) on no-reflow and prognosis in the elderly patients receiving percutaneous coronary intervention (PCI) for acute myocardial infarction(AMI). Methods A total of 280 patients with AMI admitted in our hospital from January 2017 to December 2018 were divided into normal group and no-reflow group according to the occurrence of reflow during the operation. The clinical data, the levels of LVEDP and ABI were compared between the two groups, and Logistic regression was used to analyze the risk factors of no-reflow. The patients were followed up for one year after PCI, and the incidence of major adverse cardiovascular events (MACE) was recorded and compared. The prediction value of LVEDP and ABI was analyzed by receiver operating characteristic (ROC) curve. Results The levels of LVEDP and B-type natriuretic peptide (BNP), the proportion of Killip grades Ⅲ-Ⅳ, the peak of creatine kinase isoenzyme in no-reflow group were significantly higher than those in normal group (P<0.05), and the levels of left ventricular ejection fraction (LVEF) and ABI were significantly lower than those in normal group (P<0.001). Logistic regression analysis showed that Killip classification of cardiac function, LVEDP, BNP and ABI were independent risk factors of no-reflow during PCI (P<0.05). After 1 year of follow-up, all-cause mortality (4.33% vs 11.11%) and total MACE incidence rate (16.83% vs 34.72%) in normal group were significantly lower than those in no-reflow group (P<0.05). The area under the ROC curve (AUC) of LVEDP combined with ABI predicting MACE was significantly higher than LVEDP and ABI alone (P<0.05). Conclusions LVEDP and ABI are the independent risk factors for no-reflow of AMI through PCI intervention. The combined detection shows potential application value for the prognosis prediction.

Key words: left ventricular end diastolic pressure, ankle-brachial index, acute myocardial infarction, no-reflow, prognosis

中图分类号:

R 541.4

李盛, 刘映峰, 余家凤, 李志聪, 赵鑫, 缪绯. 左室舒张末压联合踝臂指数对急性心肌梗死经皮冠状动脉介入治疗无复流及预后的预测价值[J]. 实用老年医学, 2022, 36(3): 257-260.

LI Sheng, LIU Ying-feng, YU Jia-feng, LI Zhi-cong, ZHAO Xin, MIAO Fei. Prediction value of left ventricular end-diastolic pressure combined with ankle-brachial index for no-reflow and prognosis in patients with acute myocardial infarction after percutaneous coronary intervention[J]. Practical Geriatrics, 2022, 36(3): 257-260.

参考文献

[1] DZIEWIERZ A, SIUDAK Z, TOKAREK T, et al. Determinants of stroke following percutaneous coronary intervention in acute myocardial infarction (from ORPKI Polish National Registry)[J]. Int J Cardiol, 2016, 223(1): 236-238.
[2] ZHANG C J, DENG Y Z, LEI Y H, et al. The mechanism of exogenous adiponectin in the prevention of no-reflow phenomenon in type 2 diabetic patients with acute myocardial infarction during PCI treatment[J]. Eur Rev Med Pharmacol Sci, 2018, 22(7): 2169-2174.
[3] CELIK T, KAYA M G, AKPEK M, et al. Predictive value of admission platelet volume indices for in-hospital major adverse cardiovascular events in acute ST-segment elevation myocardial infarction[J]. Angiology, 2015, 113(7): 155-162.
[4] GU G, XING H, ZHOU Y, et al. Inverse correlation between left ventricular end-diastolic pressure and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention[J]. Clin Exp Nephrol, 2017, 22(8): 808-814.
[5] SAMADOV F, YESILDAG O, SARI I, et al. Influence of collaterals on the left ventricular end-diastolic pressure and serum NT-proBNP levels in patients with coronary chronic total occlusion[J]. Egypt Heart J, 2017, 69(2): 127-132.
[6] MATSUSHITA K, BALLEW S H, SANG Y, et al. Ankle-brachial index and physical function in older individuals: The Atherosclerosis Risk in Communities (ARIC) study[J]. Atherosclerosis, 2017, 257(1): 208-215.
[7] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[8] PAPAPOSTOLOU S, ANDRIANOPOULOS N, DUFFY S J, et al. Long-term clinical outcomes of transient and persistent no-reflow following percutaneous coronary intervention (PCI): a multi-center Australian registry[J]. EuroIntervention, 2017, 14(2): S181-S181.
[9] BALTA S, CELIK T, OZTURK C, et al. The relation between monocyte to HDL ratio and no-reflow phenomenon in the patients with acute ST-segment elevation myocardial infarction[J]. Am J Emerg Med, 2016, 34(8): 1542-1547.
[10] 贾静静,董平栓,杜来景,等. 左心室舒张末期压力对行介入治疗的急性ST段抬高型心肌梗死患者的预后价值[J].中国循环杂志,2015,30(6):543-546.
[11] UNLU M, YILDIRIM A O, DEMIR M, et al. Ankle-brachial index and cardiovascular outcome[J]. Angiology, 2016, 67(2): 193.
[12] ORGAN N M, CATHERINE H. How to perform the ankle brachial index test in clinical practice[J]. Med J Aust, 2017, 207(2):60-61.
[13] RADA C, OUMMOU S, MERZOUK F, et al. Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of 370 asymptomatic patients at high cardiovascular risk[J]. J Mal Vasc, 2016, 41(6): 353-357.

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