eGFR对行直接PCI治疗的急性心肌梗死患者预后的影响

摘要

Objective To analysis between the changes of estimated glomerular filtration rate (eGFR) and major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI), and to help to improve patients'outcomes.Methods AMI patients (n=86) were chosen continuously from Department of Cardiology of Hainan Western Central Hospital from Jan.2014 to Dec.2016.All patients were divided, according to changes of eGFR, into normal eGFR group (eGFR＞90.0ml/min·1.73 m2) and abnormal eGFR group (eGFR＜90.0 ml/min·1.73 m2).The general data, results of coronary angiography (CAG) and incidence of MACE were recorded and compared between 2 groups, and the influencing factors of MACE were analyzed by using Cox proportional hazards regression model.Results The comparisons in numbers of diseased coronary vessels, infarction-related arteries and complicating lesions of left main coronary artery (LMCA) showed that the difference had no statistical significance between 2 groups (P＞0.05).The total incidence of MACE was significantly higher in abnormal eGFR group than that in normal eGFR group (P＜0.05).The analysis results of Cox proportional hazards regression model showed that age, diabetes and eGFR were risk factors of MACE occurrence (P＜0.05).Conclusion When the level of serum creatinine is in reference range, the decreased eGFR has a higher predictive value to MACE occurrence in AMI patients after primary PCI.The patients with MACE risks will be intervened for improving their prognosis.%目的分析急性心肌梗死(AMI)患者实施直接经皮冠状动脉介入术(PCI)后估算肾小球滤过率(e GFR)变化与不良心血管事件(MACE)发生的关系,帮助改善患者预后.方法连续选取2014年1月～2016年12月于海南西部中心医院心内科收治的86例急性心肌梗死患者,根据e GFR水平的高低将入选患者分为两组,即正常e GFR组(e GFR高于90.0 ml/min·1.73 m2)和异常e GFR组(e GFR低于90.0 ml/min·1.73m2).记录并比较两组患者的一般资料、冠状动脉(冠脉)造影结果、治疗后MACE发生情况,并对MACE影响因素的Cox比例风险回归模型进行分析.结果比较两组患者冠脉病变支数、梗死相关动脉及合并左冠脉主干病变等,差异均无统计学意义(P＞0.05);异常e GFR组患者的总MACE发生率显著高于正常e GFR组患者(P＜0.05);Cox比例风险回归模型分析的结果指出,年龄、糖尿病、e GFR为MACE事件发生的危险因素(P＜0.05).结论当患者血肌酐处于参考范围内,eGFR下降对于急性心肌梗死患者行直接PCI后发生MACE有较好的预测价值,从而对存在MACE发生风险的患者进行积极干预来改善预后.