论文部分内容阅读
目的:评价年龄大于80岁急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PPCI)前预防性置入主动脉内球囊反搏(P-IABP)对其短期和长期预后的影响。方法:回顾分析我院2004-01至2014-08年龄≥80岁,因STMEI而行PPCI的97例患者临床及冠状动脉(冠脉)造影和随访资料。按照术前是否P-IABP将患者分为P-IABP组(n=24)和常规PPCI组(n=73)。常规PPCI组术中或术后因血流动力学崩溃需挽救性置入IABP(R-IABP)患者12例。研究的主要终点包括PPCI术后1个月、1年及2年的死亡和术后1个月的主要不良心脑血管事件(MACCE,包括由死亡、心原性休克、新的或加重的心力衰竭(心衰)、再次心肌梗死和卒中等组成的复合事件)。使用Cox比例风险模型分析致各终点事件发生的独立预测因子。结果:P-IABP组与常规PPCI组比,术后死亡率在1个月(8.3%vs 16.4%)、1年(16.7%vs 24.7%)和2年(25.0%vs 30.1%)及术后1个月的MACCE发生率(20.8%vs 30.1%)差异均无统计学意义(P>0.05)。P-IABP组患者与常规PPCI组中R-IABP患者比,各时间点的死亡率差异均无统计学意义(P>0.05);P-IABP组术后1个月的MACCE发生率显著降低(20.8%vs 66.7%,P=0.005),并主要表现为心衰事件的显著减少(8.3%对41.7%,P=0.003),差异有统计学意义。术后TIMI血流<3级(HR=4.79,95%CI:1.59~14.39,P=0.005)是患者术后1个月死亡的独立预测因子;术后2年死亡的独立预测因子则主要为合并疾病(包括慢性阻塞性肺病、肾功能损害及贫血等。HR=3.0,95%CI:1.37~6.56,P=0.006)。结论:大于80岁STEMI患者PPCI前P-IABP跟常规PPCI短期和长期生存并无显著差异,但较R-IABP患者,P-IABP患者1个月的MACCE显著降低。PPCI前P-IABP对各终点事件均无显著的预测效应。
PURPOSE: To evaluate the efficacy and safety of prophylactic aortic balloon pump (P-IABP) before and after direct percutaneous coronary intervention (PPCI) in patients with acute ST-elevation myocardial infarction (STEMI) Long-term prognosis. Methods: Clinical and coronary angiography (coronary angiography) and follow-up data of 97 patients with PPCI in our hospital aged from 2004-01 to 2014-08 ≥ 80 years and who underwent STMEI were retrospectively analyzed. Patients were divided into P-IABP group (n = 24) and conventional PPCI group (n = 73) according to whether P-IABP preoperatively. In routine PPCI group, 12 patients with IABP (R-IABP) were saved due to hemodynamic collapse during or after operation. The primary endpoint of the study included major adverse cardiac and cardiovascular events at 1 month, 1 year, and 2 years after PPCI and at 1 month after surgery (MACCE, including death, cardiogenic shock, new or exacerbated heart failure Failure (heart failure), recurrent myocardial infarction and stroke, etc.). Cox proportional hazards models were used to analyze independent predictors of each endpoint event. Results: The P-IABP group had a significantly lower postoperative mortality rate at 1 month (8.3% vs 16.4%), 1 year (16.7% vs 24.7%) and 2 years (25.0% vs 30.1% The incidence of MACCE in one month (20.8% vs 30.1%) showed no significant difference (P> 0.05). Compared with R-IABP patients in P-IABP group and R-IABP group, there was no significant difference in mortality at any time point (P> 0.05). The incidence of MACCE in P-IABP group was significantly lower than that in R-IABP group 20.8% vs 66.7%, P = 0.005), and showed a significant reduction of heart failure (8.3% vs 41.7%, P = 0.003). The difference was statistically significant. Postoperative TIMI blood flow <3 (HR = 4.79, 95% CI: 1.59-14.39, P = 0.005) was an independent predictor of postoperative mortality at 1 month and independent predictors of 2-year postoperative mortality were Combined disease (including chronic obstructive pulmonary disease, renal dysfunction and anemia, etc. HR = 3.0, 95% CI: 1.37-6.56, P = 0.006). CONCLUSIONS: There was no significant difference in PPCI P-IABP between pre-PPCI and short-term and long-term survival in patients with STEMI over 80 years of age, but MAC-1 was significantly lower at 1 month in patients with P-IABP than in R-IABP. P-PIBI pre-P-IABP had no significant predictive effect on each endpoint.