2020 年第 3 期 第 15 卷

急性心肌梗死患者经皮冠状动脉介入治疗5年后发生心力衰竭的影响因素分析

Influence factors of heart failure 5 years after percutaneous coronary intervention for acute myocardial infarction

作者：程子超赵东晖孙浩轩杨杰何松原赵锦阳田佳瑜杨晓纯范谦

英文作者：

单位：首都医科大学附属北京安贞医院心内科二十八病房100029

英文单位：

关键词：急性心肌梗死；心力衰竭；经皮冠状动脉介入

英文关键词：

• 摘要：

• 【摘要】目的    探讨急性心肌梗死（AMI）患者接受经皮冠状动脉介入(PCI)治疗5年后心力衰竭的发生率及其影响因素。方法    回顾性分析2014年1月1日至12月31日于首都医科大学附属北京安贞医院诊断为AMI行PCI治疗的358例患者的临床资料，根据近1年内(2019年)复查超声心动图结果将患者分为心力衰竭组［左心室射血分数（LVEF）≤50%，57例］和非心力衰竭组(LVEF＞50%，301例)。采用Logistic回归方法及受试者工作特征（ROC）曲线分析心肌梗死后5年发生心力衰竭的影响因素。结果    本组AMI患者PCI治疗后5年心力衰竭发生率为15.9%（57/358）。多因素Logistic回归分析显示，年龄≥65岁（比值比＝3.962，95%置信区间1.208～8.997，P＝0.020）、术前肌钙蛋白I(TnI)（比值比＝1.033，95%置信区间1.011～1.056，P＝0.003）、术后TnI（比值比＝1.028，95%置信区间1.005～1.052，P＝0.016）、B型脑钠肽(BNP)（比值比＝1.002，95%置信区间1.000～1.003，P＝0.010）、左心室收缩末期内径(LVESD)（比值比＝1.391，95%置信区间1.112～1.727，P＝0.003）、节段性室壁运动异常（比值比＝16.371，95%置信区间1.696～157.976，P＝0.016）是AMI后发生心力衰竭的独立预测因素。ROC曲线分析显示，LVESD较BNP、术前TnI水平较术后TnI水平有着较好的预测敏感度与特异度。结论    年龄≥65岁、术前TnI水平、LVESD、节段性室壁运动异常是AMI患者PCI治疗5年后发生心力衰竭的独立预测因素。

• 【Abstract】Objective    To investigate the incidence and influence factors of heart failure 5 years after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction（AMI）. Methods    Clinical data of 358 AMI patients who had PCI in Beijing Anzhen Hospital, Capital Medical University from January 1 to December 31, 2014 were selected retrospectively. According to the results of echocardiography in 2019, the patients were divided into the heart failure group［left ventricular ejection fraction（LVEF）≤50%, n＝57］ and the non-heart failure group(LVEF＞50%, n＝301). Influence factors of heart failure 5 years after myocardial infarction were analyzed using logistic regression and receiver operating characteristic（ROC） curve. Results    Incidence rate of heart failure 5 years after PCI was 15.9%（57/358）. Multi-factor logistic regression analysis showed that age≥65 years［odds ratio（OR）＝3.962, 95% confidence interval(CI) 1.208-8.997, P＝0.020］, preoperative troponin I(TNI)(OR＝1.033, 95%CI 1.011-1.056, P＝0.003), postoperative TNI(OR＝1.028, 95%CI 1.005-1.052, P＝0.016), B-type brain natriuretic peptide(BNP)(OR＝1.002, 95%CI 1.000-1.003, P＝0.010), left ventricular end-systolic diameter(LVESD)(OR＝1.391, 95%CI 1.112-1.727, P＝0.003) and regional wall motion abnormality(OR＝16.371, 95%CI 1.696-157.976, P＝0.016) were independent predictive factors of heart failure. ROC curve analysis showed that LVESD had higher predictive sensitivity and specificity than BNP; preoperative TnI had higher predictive sensitivity and specificity than postoperative TnI. Conclusion    Age≥65 years, preoperative TnI level, LVESD and regional wall motion abnormality are independent predictive factors of heart failure 5 years after PCI treating AMI.