影响高龄STEMI患者直接PCI近期预后的相关因素分析

摘要

目的 分析高龄急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入治疗(PCI)的近期预后影响因素.方法 2010年4月至2015年4月急性STEMI患者673例,按照其年龄分为高龄组(≥80岁)及对照组(45~79岁),记录并比较两组患者住院时间、冠状动脉造影特点、PCI操作情况及PCI术后30 d预后结局,并分析影响患者30d全因死亡的危险因素.结果 两组患者的血肌酐、性别比例,吸烟史、冠心病家族史,合并慢性肾脏病、脑卒中、陈旧性心肌梗死比例,β-受体阻滞剂、ACEI/ARB使用率,碘普罗胺、碘克沙醇造影剂使用率比较,差异有统计学意义(P<0.05).两组患者症状-球囊扩张时间,冠脉单支病变、3支病变发生率,PCI置入药物洗脱支架、IABP比较,差异有统计学意义(P<0.05).高龄组住院时间,心源性休克、急性肾损伤、30 d全因病死率均高于对照组,LVEF低于对照组,差异有统计学意义(P<0.05).对STEMI患者30d内全因死亡影响因素进行回顾分析结果显示,年龄≥80岁、女性、左室前壁STEMI、合并急性肾损伤是导致患者死亡的独立风险因素、应用β-受体阻滞剂及ACEI/ARB类药物是降低患者病死率的独立预测因素.对高龄STEMI患者30d内全因死亡相关因素进行回归分析结果显示,女性(RR=4.853,95%CI:1.539~15.226)、合并急性肾损伤(RR=10.206,95%CI:3.342~31.990)是导致死亡的独立的危险因素.结论 直接PCI术对高龄急性STEMI患者的预后改善具有一定作用,但其30 d全因病死率仍显著高于<80岁的患者,这与其性别和急性肾损伤发生率存在相关性.%Objective To analyze the recent prognosis of direct PCI in STEMI patients under the guidance of clinical pathway for clearing the influence factors of clinical effect and providing a reference for the treatment of elderly patients with acute STEMI.Methods 673 cases patients with STEMTI were selected for study,which treated in our hospital during 2010.04 to 2015.04,all the patients were divided into elderly group(age is more than or equal to 80 years old)and control group(age 45 to 79 years old). According to the requirement of clinical pathway,the hospital stay, characteristics of coronary angiography,PCI operation and the prognosis were compared after 30d,and the risk factors influence the death of 30 d patients were analyzed.Results The serum creatinine,sex ratio,smoking history,family history of coronary heart disease,with chronic kidney disease,stroke,ratio of old myocardial infarction,the use rate of beta blockers,ACEI/ARB,iodine of iopromide and iodine iodixanol contrast agent had statistical difference between the two groups(P<0.05). The symptom balloon dilatation time,coronary single vessel disease,the incidence of 3 lesions,PCI into drug eluting stent or IABP had statistical difference between the two groups(P<0.05).The length of hospital stay,cardiac shock, acute kidney injury,30 d total mortality of elderly group were significantly higher than the control group,while the LVEF was significantly lower than the latter,the difference was statistically significant(P<0.05). The retrospective analysis results about the influencing factors of the died STEMI patients within 30 days showed that age≥80 years,female,left ventricular anterior wall STEMI and with acute kidney injury were the independent risk factors related the deaths of patients(P<0.05). Taken beta blockers and ACEI / ARB drugs were the independent predictor for decreasing the rate of death(P<0.05). The retrospective analysis results about the influencing factors for the death within 30 days of elderly patients with STEMI showed that the female(HR=4.853,95%CI:1.539~15.226),acute kidney injury HR=10.20695%CI:3.342~31.990)were the independent risk factors related to death within 30 days,and had statistically significant(P<0.05).ConclusionsDirect PCI can play a positive role in the improvement of the prognosis of elderly STEMI,but the mortality of elderly STEMI also higher than the patients which age<80 yeas,may have a correlation with the gender and acute kidney injury.