摘要
目的探讨急诊经皮冠状动脉介入术(PCI)后抗凝治疗对急性ST段抬高型心肌梗死(STEMI)患者预后的影响。方法446例STEMI患者根据急诊PCI术后是否使用抗凝治疗分为抗凝组和无抗凝组,收集2组STEMI患者术前基线情况(年龄、性别、心脑血管病史及PCI手术史)、术中或住院期间药物治疗情况[抗凝药物、β受体阻滞剂、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)、冻干重组人脑利钠肽、糖蛋白Ⅱb/Ⅲa受体拮抗剂(GPI)及主动脉内球囊反搏术的应用情况]及急诊PCI手术治疗情况,并进行危险分层评级(GRACE评分);抗凝组STEMI患者根据术后抗凝药物的应用情况分为依诺肝素组(n=178)和比伐卢定组(n=45),随访30 d,收集各组STEMI患者在此期间发生的主要不良心脑血管事件(MACCE)和出血事件;采用logistic回归分析STEMI患者术后抗凝治疗的相关因素,采用Cox回归分析急诊PCI术后STEMI患者使用抗凝药物及不同抗凝药物对预后的影响。结果多因素logistic回归分析表明ACEI/ARB(OR=1.569)及冻干重组人脑利钠肽(OR=1.930)是STEMI患者术后抗凝治疗的独立危险因素(P<0.05),而GRACE评分(OR=0.992)及GPI(OR=0.298)是STEMI患者术后抗凝治疗的独立保护因素(P<0.05);多因素Cox回归分析显示,术后使用抗凝剂是STEMI患者发生30 d全因死亡(HR=0.229)及MACCE(HR=0.278)的独立保护因素(P<0.05),且急诊PCI术后使用依诺肝素组患者30 d全因死亡(HR=0.215,P=0.014)及MACCE事件发生率(HR=0.291,P=0.013)较无抗凝组降低。结论术后使用抗凝药物有助于降低接受急诊PCI的STEMI患者30 d全因死亡率及MACCE发生率,且不增加出血风险。
Objective To observe the prognosis of anticoagulant therapy after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 446 STEMI patients who underwent emergent PCI operation were divided into two groups according to whether anticoagulant therapy was used:the anticoagulant group and the non-anticoagulant group.The preoperative baseline data were collected including age,gender,smoking history,hypertension,diabetes,hyperlipidemia,cerebrovascular disease,atrial fibrillation,previous history of myocardial infarction and PCI,treatment during surgery and hospitalization,anticoagulant drugs(enoxaparin or bivalirudin),β-blockers,angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blocker(ACEI/ARB),lyophilized recombinant human brain natriuretic peptide,glycoproteinⅡb/Ⅲa receptor antagonist(GPI),and intra-aortic balloon pump and the emergent PCI were evaluated by global registry of acute coronary events(GRACE)scores.According to the use of post-PCI anticoagulant drugs,the anticoagulant group was divided into the enoxaparin group(n=178)and the bivalirudin group(n=45).All cases with STEMI in the 3 groups were followed up for 30 days,and their major cardiovascular and cerebrovascular adverse events(MACCE)and bleeding events were compared.Logistic regression was used to analyze the factors related to post-PCI anticoagulant therapy.Cox regression was used to detect the effects of anticoagulant therapy and different anticoagulant subgroups after emergent PCI on prognosis.Results Multivariate logistic regression analysis showed that ACEI/ARB(OR=1.569)and lyophilized recombinant human brain natriuretic peptide(OR=1.930)were independent risk factors for postoperative anticoagulant therapy,while GRACE scores(OR=0.992)and GPI(OR=0.298)were independent protective factors for postoperative anticoagulant therapy.The difference was statistically significant(P<0.05).Multivariate Cox regression analysis showed that postoperative use of
作者
王贇
陈静
WANG Yun;CHEN Jing(Department of Cardiology,People's Hospital of Wuhan University,Wuhan 430060,Hubei,China)
出处
《贵州医科大学学报》
CAS
2022年第4期439-444,450,共7页
Journal of Guizhou Medical University
基金
国家自然科学基金(81570331)。
关键词
预后
危险因素
术后抗凝
急诊经皮冠状动脉介入术
影响
安全性
prognosis
risk factors
post-PCI anticoagulant therapy
emergency percutaneous coronary intervention(PCI)
effect
safety
