CAJ | 학술논문

目的评价左室射血分数(LVEF)对接受急诊冠状动脉介入治疗(PCI)急性ST段抬高心肌梗死患者临床预后的影响.方法 158例接受了急诊PCI急性ST段抬高心肌梗死患者纳入本研究,根据出院前的LVEF分为3组:≤40%(n=14)、41%～55%(n=46)和＞55%(n=98),临床随访平均(43.1±15.2)个月,主要不良心脏事件(MACE)发生15例.结果 3组在心肌梗死部位、梗死相关血管、单支血管病变、双支血管病变、CTnI、CK、CK-MB、高血压、糖尿病、高血脂、吸烟、肥胖、阿司匹林和氯吡格雷使用比例、氯吡格雷使用时间的差异均无统计学意义(均P＞0.05).在LVEF≤40%和41%～55%组,平均年龄显著高于LVEF＞55%组(P＜0.0001);在LVEF≤40%组,其三支病变的比例显著高于LVEF41%～55%和＞55%组(P=0.0036);在LVEF41%～55%组和＞55%组,其术后TIMI3级血流和完全血运重建的比例显著高于LVEF≤40%组(P=0.0099,P=0.0010),而Killip分级(Ⅱ,Ⅲ,Ⅳ级)的比例、平均的症状发作至球囊打开时间(SOTB)显著低于LVEF≤40%组(P=0.0100,P=0.0087).在LVEF≤40%和41%～55%组,其药物支架的比例显著低于LVEF＞55%组(P=0.0242).多因素Logistic回归分析显示,出院前LVEF是随访期总MACE发生的独立预测因素(P=0.0029),差异有统计学意义.随着LVEF的减低,在LVEF＞55%、41%～55%、≤40%组的随访期间总MACE发生率显著增加(6.12%比8.70%比35.71%,P=0.0019),随访期间总死亡和心性死亡的发生率也显著增加(1.02%比4.35%比21.43%,P=0.0090;1.02%比2.17%比14.29%,P=0.0060),差异有统计学意义.结论在接受急诊PCI的急性ST段抬高心肌梗死患者,左室射血分数是其随访期MACE发生的独立预测因子,随着LVEF的减低,其随访期MACE发生率增加.
목적 평개좌실사혈분수(LVEF)대접수급진관상동맥개입치료(PCI)급성ST단태고심기경사환자림상예후적영향.방법 158례접수료급진PCI급성ST단태고심기경사환자납입본연구,근거출원전적LVEF분위3조:≤40%(n=14)、41%～55%(n=46)화＞55%(n=98),림상수방평균(43.1±15.2)개월,주요불양심장사건(MACE)발생15례.결과 3조재심기경사부위、경사상관혈관、단지혈관병변、쌍지혈관병변、CTnI、CK、CK-MB、고혈압、당뇨병、고혈지、흡연、비반、아사필림화록필격뢰사용비례、록필격뢰사용시간적차이균무통계학의의(균P＞0.05).재LVEF≤40%화41%～55%조,평균년령현저고우LVEF＞55%조(P＜0.0001);재LVEF≤40%조,기삼지병변적비례현저고우LVEF41%～55%화＞55%조(P=0.0036);재LVEF41%～55%조화＞55%조,기술후TIMI3급혈류화완전혈운중건적비례현저고우LVEF≤40%조(P=0.0099,P=0.0010),이Killip분급(Ⅱ,Ⅲ,Ⅳ급)적비례、평균적증상발작지구낭타개시간(SOTB)현저저우LVEF≤40%조(P=0.0100,P=0.0087).재LVEF≤40%화41%～55%조,기약물지가적비례현저저우LVEF＞55%조(P=0.0242).다인소Logistic회귀분석현시,출원전LVEF시수방기총MACE발생적독립예측인소(P=0.0029),차이유통계학의의.수착LVEF적감저,재LVEF＞55%、41%～55%、≤40%조적수방기간총MACE발생솔현저증가(6.12%비8.70%비35.71%,P=0.0019),수방기간총사망화심성사망적발생솔야현저증가(1.02%비4.35%비21.43%,P=0.0090;1.02%비2.17%비14.29%,P=0.0060),차이유통계학의의.결론 재접수급진PCI적급성ST단태고심기경사환자,좌실사혈분수시기수방기MACE발생적독립예측인자,수착LVEF적감저,기수방기MACE발생솔증가.
Objective To evaluate the effect of left ventricular ejection fraction (LVEF) on clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods A total of 158 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007were enrolled. They were divided into three groups: LVEF ≤40% ( n = 14), LVEF 41% - 55 % ( n = 46)and LVEF ＞ 55% group ( n = 98 ). The clinical follow-up end-point was major adverse cardiac event (MACE) including death, acute myocardial infarction, stent thrombosis and stent restenosis. The clinical follow-up duration was 43.1 ± 15.2 months. MACE occurred in 15 patients. Results The rates of infarction site, infarction relative artery, 1-vessel disease, 2-vessel disease, hypertension, diabetes, hyperlipidemia,smoking, obesity and aspirin use were not different in three groups (P ＞0.05). Average CTnI, CK,CK-MB and duration of clopidogrel use were not different in three groups ( P ＞ 0. 05 ). The rate of 3-vessel disease was significantly higher in the LVEF≤40% group than that in the LVEF 41% -55% and LVEF ＞55% groups (P =0. 0036). The rates of TIMI flow grades (Grade Ⅲ ) and complete revascularization were significantly higher in the LVEF 41% -55% and LVEF ＞55% groups than that in the LVEF≤40% group ( P =0. 0099 ,P =0. 0010). The rates of Killip classification ( classes Ⅱ , Ⅲ, Ⅳ ) and average symptomonset-to balloon-time (SOTB) were significantly lower in the LVEF 41% -55% and LVEF ＞55% groups than that in the LVEF ≤ 40% group ( P = 0. 0100, P = 0. 0087 ). The rate of drug-eluting stents was significantly lower in the LVEF≤40% group and LVEF 41% -55% group than that in LVEF ＞55% group (P = 0. 0242). Logistic regression analysis showed that LVEF was independent predictor for MACE in the follow-up period ( P = 0. 0029 ) . With LVEF decrease, incidence of MACE in the follow-up period significantly increased in LVEF ＞55% group ,LVEF41% -55% group and LVEF≤40% group(6. 12% vs 8. 7% vs 35.71%, P = 0. 0019). Incidence of total death and cardiac death in the follow-up period significantly increased in LVEF ＞55% group ,LVEF41% -55% group and LVEF≤40% group( 1.02% vs 4.35% vs 21.43% ,P=0.0090;1.02% vs 2. 17 vs 14.29% ,P=0.0060). Conclusion In patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention,LVEF was independent predictor for MACE in the follow-up period. With LVEF decrease, incidence of MACE in the follow-up period significantly increased.