红细胞分布宽度预测急诊冠状动脉介入治疗的老年急性ST段抬高型心肌梗死病人预后的临床研究

doi:10.3969/j.issn.1003-9198.2025.11.012

摘要/Abstract

摘要： 目的探讨红细胞分布宽度(red blood cell distribution width,RDW)对老年急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)病人长期预后的预测价值。方法连续纳入2011年7月至2019年4月于南京市第一医院诊断为STEMI并行急诊冠状动脉介入治疗的老年病人,收集病人一般临床资料、实验室指标、冠状动脉造影及药物治疗数据,主要观察终点为全因死亡,次要观察终点包括再发心肌梗死、心源性死亡、缺血性卒中、支架内血栓、靶血管血运重建,主要安全终点为出血学术研究联盟(BARC)定义的3,5型大出血(BARC 3,5型)。采用Cox回归分析病人预后的影响因素。结果总计纳入625例STEMI病人,中位随访时间为72(51~96)个月,97例病人出现全因死亡。ROC曲线显示,RDW以13.45作为界值时预测STEMI病人全因死亡的价值最高,此时AUC为0.630,敏感度为43.3%,特异度为77.8%。高RDW组病人年龄、Killip Ⅲ~Ⅳ级比例、肌酐、尿酸、住院时间明显升高,而糖尿病患病比例及替格瑞洛使用比例明显降低。Kaplan-Meier 曲线显示,高RDW组全因死亡风险显著升高(log-rank P<0.001)。Cox回归分析显示,年龄、肌酐、RDW、左室射血分数、单支病变、β受体阻滞剂使用及院内主动脉内球囊反搏(IABP)为老年STMEI病人全因死亡的独立预测因素。结论 RDW作为一种廉价易得的生物标志物,可以预测老年STEMI病人长期死亡率。

关键词: 老年人, 心肌梗死, 红细胞分布宽度, 预后

Abstract: Objective To investigate the predictive value of red blood cell distribution width(RDW)for the long-term prognosis of the elderly patients with acute ST-segment elevation myocardial infarction(STEMI). Methods The elderly patients with STEMI admitted to Nanjing First Hospital from July 2011 to April 2019 were continuously enrolled. Emergent percutaneous coronary intervention(PCI)was performed in all the patients. The general clinical data,laboratory results, coronary angiography and drug therapy data were collected. The primary endpoint was all-cause mortality. The secondary endpoint was myocardial infarction, cardiovascular death, ischemic stroke, stent thrombosis and target vessel revascularization. The primary safety endpoint was major bleeding(BRAC 3,5). Cox regression analysis was conducted to discover the influencing factors for the prognosis of the patients. Results A total of 625 patients with STEMI receiving PCI in the emergency department were enrolled with a median follow-up of 72(51-96) months. All-cause mortality occured in 97 patients. Receiver operating characteristic (ROC) curve analysis showed that at a cutoff value of 13.45 for RDW showed the highest predictive value for all-cause mortality in STEMI patients, with an area under the curve of 0.630, a sensitivity of 43.3%, and a specificity of 77.8%. Patients with high RDW tended to have a higher proportion of Killip Ⅲ-Ⅳ, higher levels of age, creatinine, urea nitrogen and hospital stays. Whereas,they had a lower proportion of diabetes and ticagrelor usage. Kaplan-Meier analysis demonstrated a significantly higher all-cause mortality in the high RDW group (log-rank P<0.001). Multivariate Cox regression analysis identified that age, creatine, RDW, left ventricular ejection fraction,single-vessel disease, beta-blockers and intra-aortic ballon pump(IABP) were independent predictive factors for all-cause mortality in the elderly patients with STMEI. Conclusions RDW is an affordable biomarker for predicting long term mortality in the elderly patients with STMEI.

Key words: aged, myocardial infarction, red blood cell distribution width, prognosis

中图分类号:

R 542.22

卢红敬, 徐海梅, 赵莹莹, 金国珍, 郑亚国, 林松. 红细胞分布宽度预测急诊冠状动脉介入治疗的老年急性ST段抬高型心肌梗死病人预后的临床研究[J]. 实用老年医学, 2025, 39(11): 1130-1134.

LU Hongjing, XU Haimei, ZHAO Yingying, JIN Guozhen, ZHEN Yaguo, LIN Song. Role of red blood cell distribution width in predicting long-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction receiving percutaneous coronary intervention[J]. Practical Geriatrics, 2025, 39(11): 1130-1134.

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