直接经皮冠状动脉介入治疗前预防性置入主动脉内球囊反搏对大于80岁急性ST段抬高型心肌梗死患者的预后影响

发布时间：2018-03-18 10:30

本文选题：心肌梗死　切入点：血管成形术　出处：《中国循环杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的:评价年龄大于80岁急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PPCI)前预防性置入主动脉内球囊反搏(P-IABP)对其短期和长期预后的影响。方法:回顾分析我院2004-01至2014-08年龄≥80岁,因STMEI而行PPCI的97例患者临床及冠状动脉(冠脉)造影和随访资料。按照术前是否P-IABP将患者分为P-IABP组(n=24)和常规PPCI组(n=73)。常规PPCI组术中或术后因血流动力学崩溃需挽救性置入IABP(R-IABP)患者12例。研究的主要终点包括PPCI术后1个月、1年及2年的死亡和术后1个月的主要不良心脑血管事件(MACCE,包括由死亡、心原性休克、新的或加重的心力衰竭(心衰)、再次心肌梗死和卒中等组成的复合事件)。使用Cox比例风险模型分析致各终点事件发生的独立预测因子。结果:P-IABP组与常规PPCI组比,术后死亡率在1个月(8.3%vs 16.4%)、1年(16.7%vs 24.7%)和2年(25.0%vs 30.1%)及术后1个月的MACCE发生率(20.8%vs 30.1%)差异均无统计学意义(P0.05)。P-IABP组患者与常规PPCI组中R-IABP患者比,各时间点的死亡率差异均无统计学意义(P0.05);P-IABP组术后1个月的MACCE发生率显著降低(20.8%vs 66.7%,P=0.005),并主要表现为心衰事件的显著减少(8.3%对41.7%,P=0.003),差异有统计学意义。术后TIMI血流3级(HR=4.79,95%CI:1.59~14.39,P=0.005)是患者术后1个月死亡的独立预测因子;术后2年死亡的独立预测因子则主要为合并疾病(包括慢性阻塞性肺病、肾功能损害及贫血等。HR=3.0,95%CI:1.37~6.56,P=0.006)。结论:大于80岁STEMI患者PPCI前P-IABP跟常规PPCI短期和长期生存并无显著差异,但较R-IABP患者,P-IABP患者1个月的MACCE显著降低。PPCI前P-IABP对各终点事件均无显著的预测效应。
[Abstract]:Objective: to evaluate the short-term and long-term prognosis of patients over 80 years old with acute ST-segment elevation myocardial infarction (STEMI) before direct percutaneous coronary intervention (PPCI) with prophylactic implantation of intraaortic balloon counterpulsation (P-IABP). Methods: to evaluate the prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) before direct percutaneous coronary intervention (PPCI). Gu analyzed that the age of our hospital from January 2004 to 2014-08 was more than 80 years old, Clinical and coronary angiography and follow-up data of 97 patients with PPCI due to STMEI. Patients were divided into P-IABP group (n = 24) and routine PPCI group (n = 73) according to whether P-IABP was performed before operation. The patients in routine PPCI group needed to be saved because of hemodynamic collapse during or after operation. The main endpoints of the study included death at 1 month, 1 year and 2 years after PPCI, and major adverse cardiovascular and cerebrovascular events at 1 month after PPCI, including death. Cardiogenic shock, new or aggravated heart failure (heart failure, secondary myocardial infarction and stroke). Cox proportional risk model was used to analyze independent predictors of the occurrence of various end events. There was no significant difference in postoperative mortality in 1 month (8.3% vs 16.4), 1 year (16.7 vs 24.7) and 2 years (25.0 vs 30.1) and 1 month after operation (20.8% vs 30.1). There was no significant difference in R-IABP between the P-IABP group and the routine PPCI group. There was no significant difference in mortality at all time points. The incidence of MACCE in P-IABP group was significantly lower than that in P-IABP group at 1 month after operation. The incidence of MACCE was significantly decreased by 20.8% vs 66.7%, and the main manifestation was a significant decrease in the incidence of heart failure events by 8.3% to 41.7% P0.003. The difference was statistically significant. It is an independent predictor of death 1 month after operation. The independent predictors of death 2 years after operation were mainly complicated diseases (including chronic obstructive pulmonary disease, renal dysfunction and anemia, etc.). Conclusion: there was no significant difference in the short term and long term survival between patients with STEMI older than 80 years of age before PPCI and routine PPCI. However, compared with R-IABP patients, the MACCE of P-IABP patients was significantly lower than that of P-IABP patients at one month. There was no significant predictive effect of P-IABP on all endpoint events before PPCI.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病诊治中心;
【分类号】：R542.22

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