急性心肌梗死患者PCI术后ST段回落不良的影响因素及其预后

摘要

目的:分析研究急性心肌梗死患者直接经皮冠状动脉介入(PCI)术后ST段回落不良(STNR)的影响因素及其预后.方法:选择225例急性ST段抬高型心肌梗死患者,直接进行PCI术治疗,按性别、伴发病、术前TIMI分级、吸烟指数、症状发作-球囊扩张时间(SOTB)和术后不良事件计算STNR发生率.结果:225例患者共有69例(30.67％)发生STNR;伴发糖尿病(46.9％ vs.28.0％)、高血压(48.7％ vs.26.9％)、术前TIMI分级0～2级(34.1％ vs.20.7％)、吸烟指数≥400 (46.2％ vs.24.4％)、SOTB＞3h (46.5％ vs.26.9％)者STNR发生率明显升高(P均＜0.05),且存在术后不良事件(心绞痛、心律失常、再次心梗、心源性死亡)者STNR发生率明显高于其对应患者(10.1％比1.3％、8.7％比0.64％、4.3％比0、2.9％比0),P均＜0.05.结论:有伴发病、术前TIMI 0～2级、吸烟指数≥400及SOTB＞3h均是急性心肌梗死患者直接PCI术后ST段回落不良的重要影响因素,且ST段回落不良患者预后不佳.%Objective:To study and analyze the influencing factors and prognosis of ST-segment non-resolution (STNR) after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMD.Methods:A total of 225 patients with acute ST-segment elevation myocardial infarction (STEMI) were enrolled.All patients received primary PCI.Incidence rates of STNR were counted according to patients' genders,basic diseases,thrombolysis in myocardial infarction (TIMI) grade before PCI,smoking index,symptom-onset-to-balloon-dilatation duration (SOTB) and adverse events after PCI.Results:STNR occurred in 69 cases (30.67％) among the 225 patients; The STNR incidence rate significantly increase in patients with diabetes mellitus (46.9％ vs.28.0％),hypertension (48.7％ vs.26.9％),TIMI grade 0～2 before PCI (34.1％ vs.20.7％),smoking index ≥400 (46.2％ vs.24.4％),SOTB ＞3h (46.5％ vs.26.9％),and with adverse events after PCI [angina pectoris (10.1％ vs.1.3％),arrhythmia (8.7％ vs.0.64％),myocardial re-infarction (4.3％ vs.0),cardiogenic death (2.9％ vs.0)] in patients with STNR compared with corresponding patients,P＜0.05 all.Conclusion:Complicated diseases,TIMI grade 0～2 before operation,smoking index ≥400 and SOTB ＞3h are important influencing factors of STNR after primary PCI in AMI patients,and prognosis is poor in patients with STNR