摘要
目的 探讨急性心肌梗死(AMI)患者直接经皮冠状动脉(下称冠脉)介入治疗(PCI)术后发生院内心力衰竭(下称心衰)的预测因素。方法 回顾性选取2022年1月至2023年12月在杭州师范大学附属医院行直接PCI的217例AMI患者为研究对象,根据住院期间是否发生心衰分为心衰组88例、非心衰组129例,比较两组患者临床资料,采用多因素logistic回归分析AMI患者直接PCI术后发生院内心衰的影响因素,采用ROC曲线分析各影响因素对AMI直接PCI术后发生院内心衰的预测效能。结果 两组患者年龄、发病至血运重建时间、舒张压、收缩压、心率、血红蛋白、C反应蛋白、血清淀粉样蛋白A、肌酸激酶同工酶、心肌肌钙蛋白I、脑钠肽(BNP)、纤维蛋白原、D-二聚体、总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、乳酸脱氢酶(LDH)、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、冠脉Gensini评分、梗死相关动脉、术前心肌梗死溶栓试验血流分级等方面比较,差异均有统计学意义(均P<0.05)。年龄(OR=1.060)、收缩压(OR=0.977)、心率(OR=1.030)、BNP(OR=1.009)、LDH(OR=1.002)、冠脉Gensini评分(OR=1.012)均是AMI直接PCI术后发生院内心衰的独立影响因素(均P<0.05)。BNP、LDH、冠脉Gensini评分单项及三者联合预测AMI患者直接PCI术后发生院内心衰的AUC分别为0.769、0.757、0.724、0.865,灵敏度分别为0.784、0.659、0.659、0.779,特异度分别为0.628、0.752、0.698、0.814。结论BNP、LDH、冠脉Gensini评分三者联合可有效预测AMI患者直接PCI术后发生院内心衰风险,有助于临床早期评估病情。
Objective To investigate the predictors for the occurrence of in-hospital heart failure(HF) in patients with acute myocardial infarction(AMI) after primary percutaneous coronary intervention(PCI).Methods A total of 217AMI patients who received primary PCI at the Affiliated Hospital of Hangzhou Normal University from January 2022 to December 2023 were retrospectively selected as the study objects.They were divided into a HF group with 88 patients and a non-HF group with 129 patients based on the occurrence of HF during hospitalization.The clinical data of the two groups were compared.Multivariate logistic regression was used to analyze the influencing factors for the occurrence of in-hospital HF in AMI patients after primary PCI.ROC curve was used to analyze the predictive performance of each influencing factor on the occurrence of in-hospital HF in AMI patients after primary PCI.Results There were statistically significant differences between the two groups in age,time from disease onset to revascularization,diastolic blood pressure,systolic blood pressure,heart rate,hemoglobin,C-reactive protein,serum amyloid A,creatine kinase MB isoenzyme,cardiac troponin I,brain natriuretic peptide(BNP),fibrinogen,D-dimer,total bilirubin,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase(LDH),fasting blood glucose,total cholesterol,triglyceride,low-density lipoprotein cholesterol,coronary Gensini score,infarct related artery and preoperative thrombolysis in myocardial infarction flow classification(all P<0.05).Age(OR=1.060),systolic blood pressure(OR=0.977),heart rate(OR=1.030),BNP(OR=1.009),LDH(OR=1.002),and coronary Gensini score(OR=1.012) were all independent influencing factors for in-hospital HF in AMI patients after primary PCI(all P<0.05).The AUCs of BNP,LDH,coronary Gensini score and their combination in predicting in-hospital HF in AMI patients after primary PCI were 0.769,0.757,0.724,0.865,respectively;the sensitivity were 0.784,0.659,0.659,0.779,respectively;and the specificity were0.628,0.752,0.698,0.814,respectively.Conclusion The combination of BNP,LDH,and coronary Gensini score can effectively predict the risk of in-hospital HF occurrence in AMI patients after primary PCI,which is helpful in early clinical assessment of the condition.
作者
周新润
郑勇
董鹏
ZHOU Xinrun;ZHENG Yong;DONG Peng(Department of Cardiology,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)
出处
《心电与循环》
2025年第3期288-293,共6页
Journal of Electrocardiology and Circulation
关键词
急性心肌梗死
心力衰竭
GENSINI评分
脑钠肽
乳酸脱氢酶
Acute myocardial infarction
Heart failure
Gensini score
Brain natriuretic peptide
Lactate dehydrogenase
