曹兴阳,朱亚男,张波

• 1:营口市中心医院心内科
• 2:烟台市莱阳中心医院心内科
• 3:大连医科大学附属第一医院心内科

摘要(Abstract)：

目的探讨行直接经皮冠状动脉介入治疗(PPCI)的高龄急性ST段抬高型心肌梗死(STEMI)患者的病史特点及预后的影响因素。方法入选因STEMI就诊于大连医科大学附属第一医院并行PPCI的高龄(年龄≥75岁)患者共292例。收集患者的基线资料及住院期间的相关信息。一级研究终点为PPCI术后1年内的全因死亡;二级研究终点为PPCI术后1年内的主要不良心血管事件(MACE),包括死亡、再次血运重建、因心力衰竭再次入院治疗及新发卒中;安全终点为PPCI术后1年内开通闭塞冠状动脉策略的全球性研究(GUSTO)出血事件(包括轻微出血、中度出血及重度出血)。结果高龄STEMI患者PPCI术后1年内死亡37例(12.7%),发生MACE 125例(42.8%),发生GUSTO出血事件55例(18.8%)。Cox多因素回归分析显示:一级研究终点Killip心功能分级(HR 2.074,95%CI 1.377～3.125,P<0.001)是患者死亡的独立危险因素,估算的肾小球滤过率(HR 0.978,95%CI 0.957～0.999,P=0.040)、血管紧张素转换酶抑制药/血管紧张素Ⅱ受体拮抗药(ACEI/ARB)(HR 0.333,95%CI 0.113～0.981,P=0.046)是独立保护因素;二级研究终点Killip心功能分级(HR 1.638,95%CI 1.339～2.004,P<0.001)是患者发生MACE的独立危险因素,左心室射血分数(LVEF)(HR 0.943,95%CI 0.923～0.963,P<0.001)、β阻滞药(HR0.610,95%CI 0.390～0.953,P=0.030)是独立保护因素。安全终点Killip心功能分级(HR 1.866,95%CI1.511～2.305,P<0.001)是患者出血的独立危险因素,LVEF(HR 0.991,95%CI 0.983～0.999,P=0.022)、估算的肾小球滤过率(HR 0.610,95%CI 0.390～0.953,P=0.030)是独立保护因素。结论心功能与高龄STEMI患者行PPCI预后关系密切。Killip心功能分级是患者预后不良的独立危险因素,LVEF、ACEI/ARB、β阻滞药是患者术后1年内发生死亡、MACE或出血事件的独立保护因素。估算的肾小球滤过率是高龄STEMI患者PPCI术后1年内死亡的保护因素,也是死亡及出血事件的独立保护因素。

关键词(KeyWords)： ST段抬高型心肌梗死;经皮冠状动脉介入治疗;高龄;预后

Abstract:

Keywords:

基金项目(Foundation): 辽宁省省直医院改革重点临床科室诊疗能力建设项目（LNCCC-D18-2015）;; 大连市科技计划项目（2015E12SF168）

作者(Author): 曹兴阳,朱亚男,张波

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