摘要
目的分析急性前壁ST段抬高型心肌梗死(STEMI)患者住院期间发生心力衰竭的危险因素。方法回顾性分析2015年1月至2022年12月于厦门大学附属东南医院收治的接受经皮冠状动脉介入治疗(PCI)的急性前壁STEMI患者临床资料。全部患者根据住院期间是否发生心力衰竭将患者分为心力衰竭组(309例)和非心力衰竭组(261例)。比较两组患者的临床资料,采用多因素Logistic回归分析影响急性前壁STEMI患者院内发生心力衰竭的独立危险因素。通过受试者工作特征曲线(ROC)和曲线下面积(AUC)分析危险因素预测诊断发生心力衰竭效能。结果共纳入570例急性前壁STEMI患者,其中心力衰竭组309例(54.21%)、非心力衰竭组261例(45.79%)。多因素Logistic回归结果显示,室性心律失常(OR=5.583,95%CI:2.240~13.917,P<0.001)、存在社区获得性肺炎(OR=4.689,95%CI:2.371~9.275,P<0.001)、年龄增加(OR=1.029,95%CI:1.011~1.047,P=0.001)和N末端脑钠肽前体(NT-pro-BNP)峰值升高(OR=1.082,95%CI:1.055~1.110,P<0.001)是前壁STEMI患者发生院内心力衰竭的独立危险因素,而左室射血分数(LVEF)增加(OR=0.958,95%CI:0.936~0.982,P<0.001)是其保护因素。NT-proBNP峰值预测前壁STEMI患者发生院内心力衰竭的AUC最大为0.753,最佳诊断切点为2031 pg/dl。结论室性心律失常、社区获得性肺炎、年龄增加、LVEF降低和峰值NT-proBNP升高均是急性前壁STEMI患者发生院内心力衰竭的危险因素。
Objective To analyze the risk factors of heart failure in patients with acute anterior ST-segment elevation myocardial infarction(STEMI)during hospitalization period.Methods The clinical materials of patients with acute anterior STEMI undergone PCI were retrospectively analyzed in Dongnan Hospital of Xiamen University from Jan.2015 to Dec.2022.All patients were divided,according to occurrence of heart failure(HF),into HF group and non-HF group.The clinical materials were compared between 2 groups.The independent risk factors of nosocomial HF were analyzed by using multi-factor Logistic regression analysis.The predictive efficacy of the risk factors was analyzed by using ROC curve and AUC analyses.Results There were totally 570 patients with acute anterior STEMI,and 309(54.21%)in HF group and 261(45.79%)in non-HF group.The results of multi-factor Logistic regression analysis showed that ventricular arrhythmias(VA,OR=5.583,95%CI:2.240~13.917,P<0.001),community-acquired pneumonia(CAP,OR=4.689,95%CI:2.371~9.275,P<0.001),increased age(OR=1.029,95%CI:1.011~1.047,P=0.001)and higher N-terminal pro-brain natriuretic peptide(NT-proBNP,OR=1.082,95%CI:1.055~1.110,P<0.001)were independent risk factors of nosocomial HF,and increased left ventricular ejection fraction(LVEF,OR=0.958,95%CI:0.936~0.982,P<0.001)was a protective factor.In predicting nosocomial HF in patients with acute anterior STEMI,AUC of NT-proBNP peak value was 0.753,and the optimal diagnostic cutoff was 2031 pg/dl.Conclusion VA,CAP,increased age,decreased LVEF and increased NT-proBNP peak value are risk factors of nosocomial HF in patients with acute anterior STEMI.
作者
杨鹏
庄金龙
阮发晖
Yang Peng;Zhuang Jinlong;Ruan Fahui(The 909 Hospital of Joint Logistics Support Force(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China;不详)
出处
《中国循证心血管医学杂志》
2024年第11期1353-1357,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
福建省自然科学基金联合资金项目(2023J011835)。
关键词
心肌梗死
心力衰竭
经皮冠状动脉介入治疗
社区获得性肺炎
Myocardial infarction
Heart failure
Percutaneous coronary intervention
Community-acquired pneumonia
