血运重建治疗对合并心力衰竭急性心肌梗死患者预后影响.docxVIP

血运重建治疗对合并心力衰竭急性心肌梗死患者预后影响 【摘要】目的探讨合并心力衰竭的急性心肌梗死患者的 临床特征和预后，并分析影响其预后的因素。方法 前瞻性 连续纳入349例行急诊经皮冠脉介入治疗(PCI)的急性ST 段抬高心肌梗死(STEMI)同时合并急性心力衰竭患者，按 左室射血分数是否正常(定义为LVEF250%)将患者分为左 室射血分数正常组(LVEFN50%, n=225)和左室射血分数降 低组(LVEFV50%, n=124),分别评价患者住院期间的临床、 血管造影、超声心动图等相关资料并对患者进行长期随访。 平均随访时间为367 d, 一级终点为全因病死率。结果左室 射血分数正常组和左室射血分数降低组分别有4例(1. 8%) 和6例(4.8%)死亡，差异无统计学意义(P=0. 314)O两组 二级终点随访期间主要不良心脑血管事件差异具有统计学 意义(P=0. 022)o Cox回归分析发现，患者心功能Killip分 级水平(HR=1.092, 95%CI： 1.040?1. 149, P0. 01)是影 响患者死亡的独立预测因子。结论影响行经皮冠状动脉介 入治疗的急性心肌梗死合并心力衰竭患者的预后因素为患 者心功能分级水平；左室射血分数正常组和左室射血分数降 低组长期病死率相似。 【关键词】血运重建；急性心肌梗死；心力衰竭；预后 Effect of coronary revascularization on the prognosis of acute myocardial infarction patients complicated with heart failure XUE Zeng-ming , AN Ju-hui, ZHAO Zhi-gang, WANG Xiao, NIE Shao-ping, MA Chang-sheng. Department of Cardiology , La.ngfa.ng People s Hospital, Langfang 065000, China Correspondence author： MA Chang-sheng, Email： changshengmal23@126? com [Abstract ] Objective To explore the clinical characteristics and prog nosis of the patients of acu te myocardial infarction complicated with heart failure by analyzing the prognostic factors of these patients. Methods This was a single-center prospective study of 349 patients with acute heart failure and ECG documented ocute ST elevated myocardial infarction. All patients were treated with primary PCI. After PCI, clinical, angiographic and ECG characteristics, and prognosis of those with preserved ( 250%) or reduced (50%) left ventricular ejection fraction(LVEF) were assessed. Heart failure patients were divided into two groups： 124 with reduced EF (HFREF) and 225 with preserved EF (HFPEF)? After 367 days of average follow-up, the primary out come and nu mber of death were recorded. ResuIts Of them, 4 (1.8%) patients in the HFPEF group vs. 6 (4. 8%) in the HFREF group died. The difference in rate of death between two groups was not significant ( P=0. 314 ) . There were significa.nt difference in main adverse cardiac and cerebra vascular even