多支血管病变及术后eGFR对急性心肌梗死患者1年预后的影响

发布时间：2019-06-08 10:52

【摘要】：背景 急性心肌梗死(AMI)的预后,与治疗是否及时、梗死范围的大小以及是否有侧枝循环的建立等因素有关。AMI患者绝大多数有一支以上的冠状动脉严重受累,一定数量的患者三支主要血管均存在有临床意义的狭窄。梗死相关血管(IRA)斑块破裂和继发血栓形成是导致AMI的主要机制,虽然非梗死相关血管不作为发病的主要原因,但合并存在其他非梗死相关血管是否会增加患者的死亡率或不良事件的发生率尚不完全确定。本文就以冠脉造影结果出发,探讨病变血管数量对AMI患者预后的影响。 方法 选取浙江大学附属邵逸夫医院2009年1月至2011年11月所有行冠脉造影检查的AMI患者。收集患者住院期间资料并通过门诊或电话两种方式随访1年(12±3月)。随访联合终点为主要心脑血管不良事件(MACCE)。根据病变血管数量将所有患者分为冠脉造影阴性组、单支病变组、两支病变组和三支病变组。通过Kaplan-Meier法描述1年随访无MACCE发生率曲线,Cox回归模型分析患者1年预后的独立预测因子。 结果 493名患者中累及左主干(LM)的有39人(7.9%),累及左冠状动脉前降支(LAD)的有421人(85.4%),累及左冠状动脉回旋支(CX)的有270人(54.8%),累及右冠状动脉(RCA)的有305人(61.9%)。所有患者中有279人(56.6%)患高血压,132人(26.8%)患糖尿病。多支病变比单支病变：年龄(64.1vs.59.2,P=0.000)、高血压(59.9%vs.48.9%,P=0.031)、糖尿病(30.6%vs.17.3%,P=0.003)、既往卒中病史(8.1%vs.1.4%,P=0.006)、糖化血红蛋白(6.6vs.6.2,P=0.044)、低密度脂蛋白(2.00vs.1.83,P=0.044)。1年中72人(16.5%)发生MACCE事件。多支病变vs.单支病变：1年累积MACCE发生率(19.5%vs.10.1%,P=0.013)、再次血运重建(11.8%vs.5.8%, P=0.049). COX多因素回归提示以下三个变量对1年预后有阳性预测意义：多支病变(HR:2.445,95%CI:1.028-5.815, P=0.043)、术后eGFR60ml·min-1·1.73m-2(HR:4.245,95%CI:1.405-12.827, P=0.010)、既往卒中史(HR:3.250,95%CI:1.202-8.787, P=0.020) 肾功能方面术后eGFR60ml·min-1·1.73m-2的患者比术后eGFR≥60ml·min-1·1.73m2的患者：1年MACCE发生率(37.9%vs.13.4%,P=0.000)、1年全因死亡(25.9%vs.2.2%,P=0.000)、致死性心梗(19.0%vs.1.6%,P=0.000)。 结论 1)56.6%的AMI患者合并高血压,26.8%患者合并糖尿病。各支血管中前降支最易受累,其次为右冠、回旋支和左主干。 2)多支病变的患者年龄较大、有较多的心血管危险因素及既往卒中病史、糖化血红蛋白高、低密度脂蛋白高。 3)多支血管病变和术后eGFR水平为AMI患者1年随访MACCE的独立预测因子。 4)冠造阳性患者1年MACCE发生率为16.5%,多支病变患者1年累积MACCE发生率更高,更多的患者需要再次血运重建。 5)术后eGFR60ml·min-1·1.73m-2的患者1年MACCE发生率更高,1年全因死亡率尤其是发生致死性心梗的比例高。
[Abstract]:Background the prognosis of acute myocardial infarction (AMI) is related to the timeliness of treatment, the size of infarction size and the establishment of collateral circulation. Most patients with acute myocardial infarction have more than one coronary artery seriously involved. A certain number of patients have clinical stenosis of the three main vessels. The rupture of (IRA) plaques and secondary thrombosis of infarction-related vessels are the main mechanisms leading to AMI, although non-infarction-related vessels are not the main causes of AMI. However, it is not entirely certain whether the presence of other non-infarction-related vessels will increase the mortality or the incidence of adverse events. Based on the results of coronary angiography, the effect of the number of diseased vessels on the prognosis of patients with AMI was discussed. Methods from January 2009 to November 2011, all AMI patients who underwent coronary angiography in Shaw Hospital affiliated to Zhejiang University were selected. The data were collected during hospitalization and followed up for 1 year (12 卤3 months) by outpatient or telephone. The combined end point of follow-up was (MACCE)., the main cardiovascular and cerebrovascular adverse events. According to the number of diseased vessels, all patients were divided into three groups: coronary angiography negative group, single vessel lesion group, two vessel lesion group and three vessel lesion group. Kaplan-Meier method was used to describe the incidence curve of one-year follow-up without MACCE. Cox regression model was used to analyze the independent predictors of 1-year prognosis. Results among 493 patients, 39 (7.9%) were involved in left main coronary artery (LM), 421 (85.4%) involved left anterior descending coronary artery (LAD), and 270 (54.8%) involved left coronary artery circumflex (CX). (RCA) of the right coronary artery was involved in 305 patients (61.9%). 279 (56.6%) of all patients had hypertension and 132 (26.8%) had diabetes. Compared with single vessel lesion, age (64.1 vs.59.2, P 鈮，

本文编号：2495227