摘要
目的探讨缺血性二尖瓣反流(IMR)对急性ST段抬高型心肌梗死(STEMI)患者PCI术后临床预后的影响。方法选择中国人民解放军空军军医大学第二附属医院2010年1月—2017年1月间收治的STEMI患者531例,均于发病12 h内行PCI治疗,PCI后72 h内行超声心动图检查,根据有无二尖瓣反流将患者分入反流组(206例)、无反流组(325例),再根据二尖瓣反流程度分为轻度反流组(115例)、中度反流组(63例)、重度反流组(28例);在无反流组中按与反流组1∶1的比例随机抽取其中206例作为对照组。比较4组患者的一般资料、冠状动脉造影和PCI治疗情况,以及PCI后6个月的随访资料。结果对照组、轻度反流组、中度反流组、重度反流组患者的年龄依次增大、心率增快、收缩压降低,以及糖尿病患者比例和下壁心肌梗死患者比例增高,组间差异均有统计学意义(P值均<0.05);重度反流组下壁心肌梗死患者比例显著高于同组前壁和侧壁心肌梗死患者(P值均<0.05)。对照组、轻度反流组、中度反流组、重度反流组罪犯血管(IRA)为前降支的患者比例依次降低,IRA为右冠状动脉、左主干的患者比例依次增高,组间差异均有统计学意义(P值均<0.05);重度反流组IRA为右冠状动脉的患者比例显著高于同组IRA为前降支、回旋支、左主干、其他分支的患者(P值均<0.05)。对照组、轻度反流组、中度反流组、重度反流组的胸痛至球囊扩张时间依次延长,术后IRA心肌梗死溶栓试验(TIMI)3级患者比例依次降低;组间差异均有统计学意义(P值均<0.01)。对照组、轻度反流组、中度反流组、重度反流组住院天数依次延长,再住院率、再发心肌梗死发生率、氨基末端脑钠钛前体(NT-proBNP)水平、NYHA心功能分级Ⅲ和Ⅳ级患者比例依次增高,6 min步行距离(6MWD)依次缩短;组间差异均有统计学意义(P值分别<0.01、0.05)。对照组、轻度反流组、中度反流组、�
Objective To explore the effect of ischemic mitral regurgitation(IMR)on clinical outcomes in patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI).Methods A total of 531 STEMI patients who underwent primary PCI within 12 hours of onset from January 2010 to January 2017 were enrolled in this retrospective study.Ultrasonic cardiogram(UCG)was performed within 72 h after PCI.Mitral regurgitation(MR)occurred in 206 patients.They were divided into mild MR group(n=115),moderate MR group(n=63)and severe MR group(n=28).And 206 patients without MR from 531 STEMI patients were assigned to control group.General information,coronary arteriography,PCI results and 6-month follow-up data were compared among groups.Results The severity of MR was associated with age,heart rate,systolic pressure level,the proportion of patiants with diabetes mellitus and inferior STEMI,and there were significant differences in these indexes between groups(all P<0.05).In the severe MR group,there were more patients with inferior myocardial infarction than with anterior and lateral myocardial infarctions(P<0.05).The more severe MR was,the lower proportion of infarction-related culprit artery(IRA)in the anterior descending branch(LAD)and higher proportions of IRA in the right coronary artery(RCA)and left main coronary artery were(LMCA,all P<0.05).In the severe MR group,more IRA located in RCA than in LAD,circumflex artery,LMCA and other branches(all P<0.05).There were significant differences in the door-to-balloon time and patients’proportion of postoperative IRA thrombolysis in myocardial infarction grade 3 between groups(all P<0.01).Patients with more severe IMR had longer average length of stay,higher re-hospitalization rate,higher risk of recurrent myocardial infarction,higher N terminal pro B type natriuretic peptide(NT-proBNP)level,higher proportion of New York Heart Association grade Ⅲ and Ⅳ,and shorter 6-minute walk distance,and there were significant differences in thes
作者
陈江红
张铮
邓静玉
王承竹
杨超
党晶艺
CHEN Jianghong;ZHANG Zheng;DENG Jingyu;WANG Chengzhu;YANG Chao;DANG Jingyi(Department of Cardiology,Second Affiliated Hospital,Air Force Military Medical University,PLA,Xi’an 710038,Shaanxi,China;不详)
出处
《上海医学》
CAS
2021年第7期515-520,共6页
Shanghai Medical Journal
关键词
急性ST段抬高型心肌梗死
经皮冠状动脉介入治疗
缺血性二尖瓣反流
Acute ST-segment elevation myocardial infarction
Percutaneous coronary intervention
Ischemic mitral regurgitation
