急性心肌梗死患者PCI术中血栓事件相关危险因素及转归分析
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(1.海南省人民医院心血管内科,海南省海口市 570125;2.海南省人民医院保健中心二区,海南省海口市 570125;3.海南省西部中心医院心血管内科,海南省海口市 570125)

作者简介:

王圣,医学博士,副主任医师,研究方向为冠心病诊疗、心血管重症,E-mail为duoduoduoduoo@163.com。通信作者孙翠芳,副主任医师,研究方向为心血管康复,E-mail为9036665@qq.com。

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海南省自然科学基金项目(817305)


Analysis of risk factors and outcomes of thrombotic events during PCI in patients with acute myocardial infarction
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1.Department of Cardiology, Hainan Genaral Hospital, Haikou, Hainan 570125, China;2.Department of Health Center, Hainan Genaral Hospital, Haikou, Hainan 570125, China;3.Department of Cardiology, Hainan Western Central Hospital, Haikou, Hainan 570125, China)

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    摘要:

    目的 分析急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术中血栓事件(IPTE)的发生率、临床病变及相关危险因素等特点。探讨IPTE对于心脏结构功能及主要不良心脏事件(MACE)的影响。方法 选择2013年1月至2014年12月在海南省人民医院心血管内科连续收治的确诊为AMI并在住院期间接受PCI术的836例患者为研究对象,其中男708例,平均年龄61.05±11.96岁;女128例,平均年龄68.18±10.42岁。将PCI术中出现血栓事件的患者入选IPTE组,未出现血栓事件的患者入选NIPTE组。所有入选患者行PCI术前送检血常规、血生化、凝血功能等指标。依据GRACE评分、CURSADE评分、SYNTAX积分及血栓负荷积分等进行危险分层,并应用独立样本t检验、多因素Logistic回归等方法进行分析。结果 入选患者中出现IPTE 166例(19.86%),未出现IPTE 670例。IPTE组与NIPTE组SYNTAX积分无显著差异,但血栓负荷积分显著高于NIPTE组(1.11±0.78比0.57±0.70,P<0.001)。IPTE组患者入院时首次CK-MB(127.20±138.36 U/L比89.67±139.25 U/L,P<0.01)、首次TNT(2.30±3.04 μg/L比1.81±2.59 μg/L,P<0.05)、hs-CRP(28.90±43.97 mg/L比22.96±30.92 mg/L,P<0.05)、白细胞数(11.50±3.94 109/L比10.43±3.63 109/L,P=0.001)及Hcy(17.26±15.28 μmol/L比14.41±8.33 μmol/L,P<0.05)显著高于NIPTE组。IPTE组患者心力衰竭发生率较高(30.1%比22.2%,P<0.05),两组死亡、再梗死、心源性休克、心脏骤停等事件无显著差异。多因素Logistic回归分析显示,年龄(OR=1.039,95%CI为1.017~1.062,P<0.001)、血糖(OR=1.107,95%CI为1.023~1.197,P<0.05)、FIB降低(OR=0.758,95%CI为0.644~0.893,P<0.05)、TT缩短(OR=0.994,95%CI为0.990~0.998,P<0.01)、Hcy(OR=1.033,95%CI为1.010~1.058,P<0.01)、RBC(OR=2.078,95%CI为1.357~3.183,P<0.01)、TNT(OR=1.144,95%CI为1.048~1.249,P<0.01)以及血栓负荷积分(OR=2.773,95%CI为2.067~3.719,P<0.001)是出现IPTE的独立危险因素。结论 本研究中AMI患者PCI术中IPTE发生率为19.86%;IPTE组患者合并心力衰竭发生率较高;多因素Logistic回归分析显示年龄、血糖、FIB、TT、Hcy、RBC及血栓负荷积分是AMI患者PCI术中出现IPTE的独立危险因素。

    Abstract:

    Aim To investigate the incidence, clinical characteristics and risk factors of intraprocedural thrombotic events (IPTE) during percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and analyse the influences of IPTE on heart function and major adverse cardiac events (MACE). Methods From January 2013 to December 2014, a total of 836 consecutive AMI patients from Hainan General Hospital who underwent PCI were enrolled in this study (708 male, aged 61.05±11.96 years; 128 female, aged 68.18±10.42 years). The patients with thrombotic events occurred during PCI were enrolled in IPTE group. The patients without thrombotic events were enrolled in non intraprocedural thrombotic events (NIPTE) group. Blood routine test, biochemical test and coagulation test were obtained before PCI. Risk stratification were noted by the GRACE scores, CURSADE scores, SYNTAX scores and thrombus burden scores. Independent sample t test, multiple Logistic regression analysis and other testing methods were applied. Results IPTE occurred in 166 cases (19.86%) during PCI, 670 cases were enrolled in NIPTE group. There was no significant difference between the two groups in SYNTAX scores. Thrombus burden scores were higher in IPTE group than those in NIPTE group (1.11±0.78 vs. 0.57±0.70, P<0.001). The level of admission CK-MB (127.20±138.36 U/L vs. 89.67±139.25 U/L, P<0.01), admission TNT (2.30±3.04 μg/L vs. 1.81±2.59 μg/L, P<0.05), hs-CRP (28.90±43.97 mg/L vs. 22.96±30.92 mg/L, P<0.05), counts of white blood cell (11.50±3.94 109/L vs. 10.43±3.63 109/L, P=0.001) and Hcy (17.26±15.28 μmol/L vs. 14.41±8.33 μmol/L, P<0.05) were higher in IPTE group than those in NIPTE group. The incidence of heart failure was higher in IPTE group than that in NIPTE group (30.1% vs. 22.2%, P<0.05). There were no significant difference of cardiovascular death, reinfarction, cardiac shock, sudden death and MACE between the two groups. Multiple Logistic regression analysis showed age (OR=1.9,5%CI was 1.017~1.062, P<0.001), GLU (OR=1.7,5%CI was 1.023~1.197, P<0.05), reduced FIB (OR=0.8,5%CI was 0.644~0.893, P<0.05), shortened TT (OR=0.4,5%CI was 0.990~0.998, P<0.01), Hcy (OR=1.3,5%CI was 1.010~1.058, P<0.01), RBC (OR=2.8,5%CI was 1.357~3.183, P<0.01) and thrombus burden scores (OR=2.3,5%CI was 2.067~3.719, P<0.001) were independent risk factors associated with IPTE. ConclusionsThe incidence of IPTE during PCI in AMI patients was 19.86% in our study. The patients with IPTE presented higher incidence of heart failure. Age, GLU, FIB, TT, Hcy, RBC and thrombus burden scores were independent risk factors associated with IPTE.

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王圣,孙翠芳,吴钟伟,王裕岱,黄修献,卢思稼,董小莉,帅付杰,李斌.急性心肌梗死患者PCI术中血栓事件相关危险因素及转归分析[J].中国动脉硬化杂志,2018,26(9):913~919.

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  • 收稿日期:2018-04-23
  • 最后修改日期:2018-05-28
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  • 在线发布日期: 2018-10-16