摘要
目的:探讨接受介入治疗的高龄(≥75岁)急性ST段抬高型心肌梗死(STEMI)患者的临床特征及预后。方法:回顾性连续收集2015-07-2017-12在我院行直接经皮冠状动脉介入治疗(PPCI)的139例高龄(≥75岁)急性STEMI患者的临床资料。分析患者的基本临床资料、冠状动脉造影、临床用药以及术后预后情况,并对介入治疗预后不良事件的影响因素进行单因素和多因素分析。结果:接受介入治疗的高龄急性STEMI患者大多数具有高血压和血脂异常合并症,分别占总数的66.9%(93例)和93.5%(130例)。临床用药数据表明,使用利尿剂的患者较少,只占总数的30.2%(42例)。急性前壁下壁心肌梗死和急性前壁心肌梗死患者占总数的92.1%(128例)。1年随访表明,介入治疗预后良好的患者占61.2%(65例)。年龄>85岁、左心室射血分数(LVEF)≤50%、心率>75次/min的患者预后不良事件的发生率均较高(P<0.05)。多因素分析表明,高龄(OR=2.503,95%CI:1.014~6.179,P=0.047)及高心率(OR=2.928,95%CI:1.379~6.216,P=0.005)是影响介入后高龄急性STEMI患者预后的独立危险因素,而LVEF是保护因素(OR=0.365,95%CI:0.174~0.769,P=0.008)。结论:高龄、低LVEF、高心率是高龄急性STEMI患者PPCI术后预后不良的危险因素。
Objective:To investigate the clinical characteristics and prognosis of elderly patients with acute ST-segment elevation myocardial infarction(STEMI) who underwent interventional therapy.Method:The clinical data of 139 consecutive elderly patients(≥75 years old)with acute STEMI who underwent primary percutaneous coronary intervention(PPCI) in our hospital from July 2015 to December 2017 were retrospectively collected.The patient’s basic clinical data,coronary angiography,clinical medication and postoperative prognosis were analyzed.And factors influencing the adverse prognosis of PPCI therapy were analyzed by univariate and multivariate analysis.Result:Most of elderly patients with acute STEMI received PCI had hypertension(66.9%,n=93) and dyslipidemia 93.5%(n=130).Analysis of clinical medication data showed that fewer patients were treated with diuretics,accounting for only 30.2%(n=42).Patients with acute anterior inferior wall myocardial infarction and acute anterior wall myocardial infarction accounted for 92.1%(n=128).One-year follow-up showed that patients with good prognosis of interventional therapy accounted for 61.2%(n=65).The incidence of prognostic adverse events was higher in patients >85 years of age,left ventricular ejection fraction(LVEF)≤50%,and heart rate >75 times/min,respectively(P<0.05).Multivariate analysis showed that advanced age(OR=2.503,95%CI:1.014-6.179,P=0.047) and higher heart rate(OR=2.928,95%CI:1.379-6.216,P=0.005) were independent risk factors for poor prognosis in elderly patients with STEMI after PCI,and LVEF was a protective factor for poor prognosis in elderly patients with STEMI after PCI(OR=0.365,95%CI:0.174-0.769,P=0.008).Conclusion:Advanced age,lower LVEF,and higher heart rate are risk factors for poor prognosis in elderly patients with acute STEMI after PCI.
作者
马娜
顾明
MA Na;GU Ming(Department of Cardiology,The Occupational Disease Prevention and Treatment Institute of Tianjin,Tianjin,300011,China)
出处
《临床心血管病杂志》
CAS
北大核心
2019年第12期1119-1123,共5页
Journal of Clinical Cardiology
关键词
高龄
急性ST段抬高型心肌梗死
经皮冠状动脉介入治疗
预后
elderly patients
acute ST-segment elevation myocardial infarction
percutaneous coronary intervention
prognosis
