摘要
目的:评估左室相对室壁厚度(RWT)对急性ST段抬高型心肌梗死(STEMI)患者临床结局的预测价值。方法:2011年11月—2017年12月于南京鼓楼医院行急诊冠状动脉(冠脉)介入治疗的675例STEMI患者被纳入研究。有3种计算RWT的方法RWT_(PW)=2×PWth/LVDd;RWT_(IVS+PW)=(IVSth+PWth)/LVDd;RWT_(IVS)=2×IVSth/LVDd(PWth:左室后壁厚度;LVDd:左室舒张末期内径;IVSth:室间隔厚度)。根据RWT的中位数分为低值组和高值组,比较两组的基线特征,评估两组患者5年心源性死亡和主要不良心血管事件(MACE)的发生率,并通过COX比例风险模型探讨RWT的预测价值。结果:RWT_(PW)、RWT_(IVS+PW)低值组的心源性死亡率和MACE事件累计发生率均高于高值组。RWT_(IVS)组间生存分析无统计学意义。多因素COX回归模型显示RWT_(PW)、RWT_(IVS+PW)是STEMI患者发生远期心源性死亡及MCAE事件的独立预测指标。但亚组分析表明3种RWT计算方法对前壁心肌梗死患者临床结局没有预测价值,而RWT_(PW)是非前壁心肌梗死的STEMI患者最稳定的独立预测指标(HR:0.56,95%CI:0.35~0.91,P=0.017)。结论:RWT_(PW)、RWT_(IVS+PW)以及RWT_(IVS)对于前壁心肌梗死患者远期临床结局均无预测价值。对于STEMI中非前壁心肌梗死患者,RWT_(PW)是最有效的独立预测指标。
Objective:The study was performed to evaluate the prognostic value of relative wall thickness(RWT)in the patients with ST-segment elevation myocardial infarction(STEMI).Methods:A total of 675 STEMI patients who had undergone primary percutaneous coronary intervention(pPCI)were enrolled from November 2010 to December 2017 in Nanjing Drum Tower Hospital.There were three methods to calculate RWT:RWT_(PW)=2×PWth/LVDd;RWT_(IVS+PW)=(IVSth+PWth)/LVDd;RWTIVS=2×IVSth/LVDd(IVSth:intraventricular septal thickness;LVDd:LV diameter at end of diastole;PWth=posterior wall thickness).The patients were divided into two groups based on the three median values of the RWT and the baseline characteristics of the two groups were compared.The incidence rate of cardiac death and major adverse cardiac events(MACE)of the two groups at five years were assessed and COX proportional hazard models were established for evaluation of the predictive value of the RWT.Results:The incidence of cardiac death and MACE were both higher in the Low-RWT_(PW)and Low-RWT_(IVS+PW) group compared to the corresponding High group.But there was no statistical significance between the Low and High RWTIVS groups.Multiple COX regression analysis indicated that RWT_(PW) and RWT_(IVS+PW) were the independent predictors of the cardiac death and MACE in the patients with STEMI.But the subgroup analysis showed three calculation of RWT had no predictive value on the clinical outcome of the patients with anterior myocardial infarction.However,RWT_(PW)was the most reliable independent predictor of the long term prognosis in the patients with non-anterior wall group(HR:0.56,95%CI:0.35-0.91,P=0.017).Conclusion:None of RWT_(PW),RWT_(IVS+PW) and RWTIVS had predictive value on the long term clinical outcomes for the patients with anterior myocardial infarction.On the contrary,RWT_(PW)was the most effective predictors of the STEMI patientes with non-anterior infarction.
作者
张颖
乔帅华
陈建州
郑红艳
李冠男
张静梅
魏钟海
ZHANG Ying;QIAO Shuaihua;CHEN Jianzhou;ZHENG Hongyan;LI Guannan;ZHANG Jingmei;WEI Zhonghai(Department of Cardiology,Drum Tower Hosptial,Medical School of Nanjing University,Nanjing,210008,China;Department of Cardiology,Yizheng Hospital,Nanjing Drum Tower Hospital Group)
出处
《临床心血管病杂志》
CAS
北大核心
2021年第5期411-417,共7页
Journal of Clinical Cardiology
基金
国家自然科学基金项目(No:81700389)
南京市医学科技发展基金项目(No:YKK19063)。
