中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2014年
10期
822-826
,共5页
王锦纹%陈韵岱%王长华%朱小玲
王錦紋%陳韻岱%王長華%硃小玲
왕금문%진운대%왕장화%주소령
心肌梗死%肾上腺素能β受体阻滞剂%无复流现象
心肌梗死%腎上腺素能β受體阻滯劑%無複流現象
심기경사%신상선소능β수체조체제%무복류현상
Myocardial infarction%Adrenergic beta-antagonists%No-reflow phenomenon
目的 探讨急性ST段抬高型心肌梗死患者既往服用β受体阻滞剂与直接经皮冠状动脉介入治疗(PCI)后发生无复流的相关性.方法 入选北京安贞医院和解放军总医院2007年1月至2011年6月入院的发病12 h内行PCI的急性ST段抬高型心肌梗死患者1 615例进行回顾性分析.将患者分为β受体阻滞剂组(入院前服用β受体阻滞剂≥1个月,共257例)和非β受体阻滞剂组(入院前服用β受体阻滞剂＜1个月或未服用β受体阻滞剂,共1 358例).无复流定义为置入支架后最后一帧冠状动脉影像的血流TIMI分级＜3级.采用多因素logistic回归分析直接PCI后无复流的独立危险因素.结果 β受体阻滞剂组患者直接PCI后无复流的发生率低于非β受体阻滞剂组[13.6％ (35/257)比21.2％(289/1 358),P=0.017].多因素logistic回归分析显示,入院前服用β受体阻滞剂(OR =0.594,95％CI:0.394～0.893,P=0.012)是直接PCI后发生无复流的保护因素,年龄≥55岁(OR=2.734,95％CI:1.959 ～ 3.817,P＜0.001)、中性粒细胞计数(OR=1.257,95％ CI:1.169 ～1.351,P＜0.001)、入院时血糖水平(OR=1.060,95％CI:1.018 ～1.103,P=0.004)、术前心功能Ⅳ级(Killip分级)(OR=3.383,95％CI:1.924 ～5.948,P＜0.001)、再灌注时间≥4h(OR=1.503,95％ CI:1.124 ～2.009,P=0.006)是直接PCI后发生无复流的独立危险因素.结论 长期服用β受体阻滞剂与急性ST段抬高型心肌梗死患者直接PCI后无复流的发生率降低有关.
目的 探討急性ST段抬高型心肌梗死患者既往服用β受體阻滯劑與直接經皮冠狀動脈介入治療(PCI)後髮生無複流的相關性.方法 入選北京安貞醫院和解放軍總醫院2007年1月至2011年6月入院的髮病12 h內行PCI的急性ST段抬高型心肌梗死患者1 615例進行迴顧性分析.將患者分為β受體阻滯劑組(入院前服用β受體阻滯劑≥1箇月,共257例)和非β受體阻滯劑組(入院前服用β受體阻滯劑＜1箇月或未服用β受體阻滯劑,共1 358例).無複流定義為置入支架後最後一幀冠狀動脈影像的血流TIMI分級＜3級.採用多因素logistic迴歸分析直接PCI後無複流的獨立危險因素.結果 β受體阻滯劑組患者直接PCI後無複流的髮生率低于非β受體阻滯劑組[13.6％ (35/257)比21.2％(289/1 358),P=0.017].多因素logistic迴歸分析顯示,入院前服用β受體阻滯劑(OR =0.594,95％CI:0.394～0.893,P=0.012)是直接PCI後髮生無複流的保護因素,年齡≥55歲(OR=2.734,95％CI:1.959 ～ 3.817,P＜0.001)、中性粒細胞計數(OR=1.257,95％ CI:1.169 ～1.351,P＜0.001)、入院時血糖水平(OR=1.060,95％CI:1.018 ～1.103,P=0.004)、術前心功能Ⅳ級(Killip分級)(OR=3.383,95％CI:1.924 ～5.948,P＜0.001)、再灌註時間≥4h(OR=1.503,95％ CI:1.124 ～2.009,P=0.006)是直接PCI後髮生無複流的獨立危險因素.結論 長期服用β受體阻滯劑與急性ST段抬高型心肌梗死患者直接PCI後無複流的髮生率降低有關.
목적 탐토급성ST단태고형심기경사환자기왕복용β수체조체제여직접경피관상동맥개입치료(PCI)후발생무복류적상관성.방법 입선북경안정의원화해방군총의원2007년1월지2011년6월입원적발병12 h내행PCI적급성ST단태고형심기경사환자1 615례진행회고성분석.장환자분위β수체조체제조(입원전복용β수체조체제≥1개월,공257례)화비β수체조체제조(입원전복용β수체조체제＜1개월혹미복용β수체조체제,공1 358례).무복류정의위치입지가후최후일정관상동맥영상적혈류TIMI분급＜3급.채용다인소logistic회귀분석직접PCI후무복류적독립위험인소.결과 β수체조체제조환자직접PCI후무복류적발생솔저우비β수체조체제조[13.6％ (35/257)비21.2％(289/1 358),P=0.017].다인소logistic회귀분석현시,입원전복용β수체조체제(OR =0.594,95％CI:0.394～0.893,P=0.012)시직접PCI후발생무복류적보호인소,년령≥55세(OR=2.734,95％CI:1.959 ～ 3.817,P＜0.001)、중성립세포계수(OR=1.257,95％ CI:1.169 ～1.351,P＜0.001)、입원시혈당수평(OR=1.060,95％CI:1.018 ～1.103,P=0.004)、술전심공능Ⅳ급(Killip분급)(OR=3.383,95％CI:1.924 ～5.948,P＜0.001)、재관주시간≥4h(OR=1.503,95％ CI:1.124 ～2.009,P=0.006)시직접PCI후발생무복류적독립위험인소.결론 장기복용β수체조체제여급성ST단태고형심기경사환자직접PCI후무복류적발생솔강저유관.
Objective To investigate the impact of pre-primary percutaneous coronary intervention (PCI) β blocker use on the development of no-reflow in ST-segment elevation myocardial infarction (STEMI) patients post PCI.Methods We retrospectively evaluated 1 615 outpatients with STEMI who underwent primary primary PCI with in 12 hours from symptom onset admitted to Beijing Anzhen Hospital and Chinese people's liberation army general hospital from January 2007 to June 2011.The study population was divided into the following 2 groups:β blocker group (pretreatment with β blockers ≥ one month before admission,n =257) and non-β blockers group (pretreatment with β blockers ＜ one month before admission or had no β blocker,n =1 358).No-reflow was defined as TIMI grade ＜ 3 in last imaging of coronary artery after stenting.Multivariable logistic regression analyses were used to identify independent predictors for the no-reflow after primary PCI.Results Incidence of the no-reflow was significantly lower in the β blocker group than in non-β blockers group (13.6％ (35/257) vs.21.2％ (289/1 358),P =0.017).Multivariable logistic regression analysis revealed that pre-PCI β blocker use was a protective predictor of the no-reflow (OR =0.594,95％ CI:0.394-0.893,P =0.012),while age ≥ 55 years old (OR =2.734,95％ CI:1.959-3.817,P ＜ 0.001),high neutrophil count (OR =1.257,95％ CI:1.169-1.351,P ＜ 0.001),admission plasma glucose (OR =1.060,95％ CI:1.018-1.103,P =0.004),Killip classes Ⅳ (OR =3.383,95％ CI:1.924-5.948,P ＜ 0.001) and reperfusion time ≥ 4 h (OR =1.503,95％ CI:1.124-2.009,P =0.006) were risk factors for the development of no-reflow post PCI.Conclusion Previous long term β blockers use before STEMI is associated with lower incidence of no-reflow in patients with STEMI treated with primary PCI.
