2018 年第 7 期 第 13 卷

急性非ST段抬高型心肌梗死合并外周动脉疾病史患者的临床特点及发生院内不良事件的危险因素

Clinical characteristics of acute non-ST-segment elevation myocardial infarction in patients with peripheral artery disease history and risk factors of in-hospital adverse events

作者：康云鹏郭雯刘文娴陈立颖康铁朵

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科监护室北京市心肺血管疾病研究所

英文单位：

关键词：心肌梗死；外周动脉疾病；院内不良事件

英文关键词：

• 摘要：

• 【摘要】目的    探讨合并外周动脉疾病（PAD）史的急性非ST段抬高型心肌梗死（NSTEMI）患者的临床特点及发生院内不良事件的危险因素。方法    回顾性分析2010年1月至2017年11月首都医科大学附属北京安贞医院心内科监护室收治的急性NSTEMI患者430例，其中合并PAD史者68例，未合并PAD史者362例。收集患者的临床资料和冠状动脉病变特点，以及院内不良事件发生情况。以是否发生院内不良事件进行多因素Logistic回归分析，得出NSTEMI患者发生院内不良事件的危险因素。结果    NSTEMI合并PAD史组的高血压史比例、入院收缩压、血肌酐、总胆固醇、低密度脂蛋白胆固醇水平高于，左心室舒张末期内径（LVEDD）大于未合并PAD史组，差异均有统计学意义（均P＜0.05）。NSTEMI合并PAD史组多支血管病变比例明显高于未合并PAD史组［15.1%（10/68）比9.7%（35/362）］（P＝0.02）。NSTEMI合并PAD史组患者院内死亡率明显高于未合并PAD史组［7.4%（5/68）比1.9%（7/362）］（P＝0.02）。通过多因素Logistic回归模型分析得出，存在PAD史（比值比＝2.396，P＝0.024）、高血压史（比值比＝1.647，P＝0.011）、LVEDD增大（比值比＝1.113，P＝0.001）和收缩压＜90 mmHg（1 mmHg=0.133 kPa，比值比＝2.223，P＝0.025）是急性NSTEMI患者发生院内不良事件的独立危险因素。结论    合并PAD史的NSTEMI患者病情重，多支血管病变常见，院内死亡率高；PAD史、高血压史、LVEDD增大和收缩压＜90 mmHg是急性NSTEMI患者发生院内不良事件的独立危险因素。

• 【Abstract】Objective    To investigate the clinical characteristics of acute non-ST-segment elevation myocardial infarction（NSTEMI） with peripheral artery disease（PAD） history and the risk factors of in-hospital adverse events. Methods    Clinical records of 430 acute NSTEMI patients admitted in Cardiac Care Unit, Beijing Anzhen Hospital, Capital Medical University from January 2010 to November 2017 were reviewed; 68 patients had PAD history. Clinical general information, characteristics of coronary artery disease and occurrence of in-hospital adverse events were analyzed. Risk factors of in-hospital adverse events were analyzed by multivariate Logistic regression. Results    Ratio of hypertension history, levels of systolic pressure, serum creatinine, total cholesterol, low-density lipoprotein cholesterol and left ventricular end-diastolic dimension（LVEDD） in NSTEMI with PAD group were significantly higher than those in NSTEMI without PAD group（P＜0.05）. Ratio of multivessel disease in NSTEMI with PAD group was significantly higher than that in NSTEMI without PAD group［15.1%（10/68） vs 9.7%（35/362）］（P＝0.02）. In-hospital death rate in NSTEMI with PAD group was significantly higher than that in NSTEMI without PAD group［7.4%（5/68） vs 1.9%（7/362）］（P＝0.02）. Multivariate logistic regression showed that PAD history（odds ratio＝2.396， P＝0.024）, hypertension history（odds ratio＝1.647， P＝0.011）, LVEDD increase（odds ratio＝1.113， P＝0.001） and systolic pressure＜90 mmHg（odds ratio＝2.223， P＝0.025） were independent risk factors of in-hospital adverse events in acute NSTEMI patients. Conclusion    Acute NSTEMI patients with PAD history have a high in-hospital death rate; multivessel disease is common; PAD history, hypertension history, LVEDD increase and systolic pressure＜90 mmHg are independent risk factors of in-hospital adverse events.

  【Key words】Myocardial infarction;Peripheral arterial disease;In-hospital adverse events

  【Fund program】Health Scientific and Technological Achievements Promotion Project of Beijing Municipal Commission of Health and Family Planning（TG-2017-34）