目的 探讨老年女性ST段抬高型心肌梗死(STEMI)合并多支血管病变(MVD)患者直接PCI预后的影响因素.方法 回顾性收集2005年1月～2015年1月就诊于北京安贞医院年龄≥60岁的诊断为STEMI合并MVD并完成直接PCI的女性患者148例,平均随访4年,根据患者是否发生主要心血管不良事件(MACE)分为MACE组50例和非MACE组98例.利用Cox回归分析影响患者预后的主要因素.结果 MACE组患者红细胞比容明显低于非MACE组[(32.15±15.38)％ vs (36.66±13.58)％,P=0.017].胸痛到直接PCI时间＞6 h患者较＜2h患者远期发生MACE的风险增加3.299倍(95％CI:1.290～8.438,P＜0.05);估算肾小球滤过率是患者预后的影响因素(HR=2.472,95％CI:1.129～5.410,P＜0.05);支架置入前行球囊预扩张是患者的保护因素(HR=0.455,95％CI:0.227～0.911,P＜0.05).结论 直接PCI术前时间延误及肾功能下降是老年女性STEMI合并MVD患者的主要危险因素,而术前使用球囊预扩张是其重要的保护因素.%Objective To study the influencing factors of prognosis in elderly female ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) after primary PCI.Methods One hundred and forty-eight ≥60 years old female STEMI patients with MVD admitted to our hospital for primary PCI from January 2005 to January 2015 were followed up for 4 years.They were divided into MACE group (n=50) and MACE-free group (n=98).The major influencing factors of prognosis in two groups were analyzed by Cox regression analysis.Results The specific volume of erythrocytes was significantly lower in MACE group than in MACE-free group (32.15％±15.38％ vs 36.66％±13.58％,P=0.017).The risk of long-term MACE was 3.299-fold higher in patients with their time from chest pain to primary PCI ＞6 h than in those with their time from chest pain to primary PCI＜2 h (95 ％ CI:1.290-8.438,P＜0.05).Estimated glomerular filtration rate was a risk factor for the prognosis of STEMI patients with MVD (HR=2.472,95 ％CI:1.129-5.410,P＜0.05).Balloon predilation before stenting was a protective factor for the prognosis of STEMI patients with MVD (HR=0.455,95 ％CI:0.227-0.911,P＜0.05).Conclusion Delayed primary PCI and decreased renal function are the risk factors for elderly female STEMI patients with MVD and balloon predilation is a protective factor for elderly female STEMI patients with MVD before stenting.
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