PCI相关心肌梗死的危险因素及预后回顾性分析

发布时间：2019-01-02 19:18

【摘要】：目的:观察广西医科大学第一附属医院西院心血管内科PCI相关心肌梗死的发生率及危险因素,为PCI相关心肌梗死的防治提供一定的临床参考。方法:符合入组条件276例术前cTn I正常的患者择期行经皮冠状动脉介入治疗(PCI)术,根据术后48h内肌钙蛋白I(cTnI)检测值分为三组,I组(cTnI正常组,cTnI≤0.033 ng/mL,167例);II组(PCI相关心肌损伤组,0.033 ng/mLcTnI≤0.165 ng/mL,51例);III组(PCI相关心肌梗死组,cTnI0.165ng/mL,58例)。通过对三组患者术前一般临床资料、血生化指标、冠脉造影特点及PCI术中操作参数指标等因素进行观察比较,利用Logistic回归分析PCI相关心肌梗死的重要危险因素。术后6-24个月随访,比较PCI术后MACE发生率。结果:276例择期PCI患者中,术后c TnI在正常范围内患者有167例(60.50%),cTn I超过正常值上限但小于5倍患者有51例(18.47%),cTnI超过正常值上限5倍患者有58例(21.01%)。与I组对比,II组、III组患者术前hs-CRP[(1.21±0.56)vs(2.22±0.83)vs(3.66±1.39)mg/L,P0.001]差异有统计学意义,且cTnI与hs-CRP呈正相关;II组、III组中多支血管病变(39.53%vs 64.71%vs 75.86%,P0.001),C型血管病变(47.90%vs 56.86%vs 74.14%,P0.001)患者所占比率要高于I组;比较三组患者PCI术中操作参数:发现I组与II组及III组在支架数目[(1.14±0.35)vs(1.27±0.45)vs(1.55±0.56)个,P0.001]、支架总长度[(30.16±14.27)vs(35.94±14.23)vs(38.68±17.10)mm,P=0.042]、球囊总个数[(2.03±0.52)vs(2.39±0.14)vs(3.12±1.18)个,P=0.002]、囊扩张最大压力[(13.62±4.46)vs(14.58±4.36)vs(15.67±3.18)atm,P=0.042]方面比较,三者间差异均有统计学意义;Logistic回归分析结果显示,hs-CRP、支架总长度、多枚支架植入、C型血管病变是PCI相关心肌梗死的重要危险因素。术后6-24个月随访,发现I组中有3例患者发生MACE(2例心力衰竭,1例再次行TVR),II组中有4例患者发生MACE(1例心力衰竭,1例再发急性心肌梗死,2例再次行TVR),III组中有2例患者发生MACE(1例心力衰竭,1例再发急性心肌梗死),三组患者短期MACE发生率(1.80%vs 7.84%vs 3.45%,P=0.103)比较,差异无统计学意义。结论:1、我院西院心血管内科PCI相关心肌损伤发生率为18.47%,PCI相关心肌梗死发生率为21.01%;2、hs-CRP、支架总长度、多枚支架植入、C型血管病变是PCI相关心肌梗死的重要危险因素;3、术后6-24个月随访,PCI相关心肌梗死并不增加患者MACE发生率。
[Abstract]:Objective: to observe the incidence and risk factors of PCI related myocardial infarction in the Department of Cardiovascular Medicine, West Hospital, first affiliated Hospital of Guangxi Medical University, and to provide some clinical reference for the prevention and treatment of PCI related myocardial infarction. Methods: 276 patients with normal cTn I before operation underwent percutaneous coronary intervention (PCI). According to the values of cardiac troponin I (cTnI) in 48 hours after operation, they were divided into three groups: group I (cTnI normal group, cTnI 鈮，

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