【摘要】 目的:探讨接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者住院期间发生射血分数保留型心力衰竭(HFpEF)的预测因素及预后。方法:选择2015年10月至2016年10月在大连市6家医院接受直接PCI的627例急性STEMI患者。根据是否符合HFpEF诊断标准分为两组:HFpEF组(n=100)、射血分数保留型非心力衰竭(pEF)组(n=527)。收集并记录两组患者的基线临床资料及直接PCI后1年主要不良心脑血管事件(MACCE)的发生情况。应用多因素Logistic回归分析评估急性STEMI患者住院期间发生HFpEF的预测因素,Kaplan-Meier生存曲线比较两组患者直接PCI后1年预后。结果:627例急性STEMI患者的平均年龄为(61.2±12.3)岁。与pEF组相比,HFpEF组患者平均年龄较大,女性比例较高,吸烟者比例较低,既往脑卒中、肾功能不全比例较高,收缩压及舒张压较低,心率较快,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,年龄较大(OR=1.027)、女性(OR=2.052)、脑卒中病史(OR=3.246)、肾功能不全(OR=2.001)、心率较快(OR=1.030)、左心室舒张末期内径(LVEDd)较大(OR=1.074)与急性STEMI患者直接PCI后住院期间HFpEF发生风险增加独立相关(P均<0.05)。Kaplan-Meier生存分析显示,HFpEF组直接PCI后1年MACCE发生率显著高于p EF组(19.0%vs. 5.3%,log-rank检验P<0.001)。结论:在接受直接PCI的急性STEMI患者中,与pEF组比较,HFpEF组患者直接PCI后1年MACCE风险显著增加。年龄较大、女性、既往脑卒中、肾功能不全、心率较快、LVEDd较大是住院期间HFpEF发生的独立预测因素。更多还原

【Abstract】 Objectives: To investigate the predictors and prognosis of heart failure with preserved ejection fraction(HFpEF) in a homogeneous acute ST-segment elevation myocardial infarction(STEMI) patients population undergoing primary percutaneous coronary intervention(PCI). Methods: 627 patients, who were diagnosed with acute STEMI in 6 hospitals in Dalian from October 1 st 2015 to October 31 st 2016 were enrolled. According to the diagnostic criteria of HFpEF, patients were divided into HFpEF group(n=100) and pEF group(n=527). Clinical data, cardio-cerebral vascular major adverse events(MACCE) were collected and recorded. Multivariate logistic regression analysis was performed to evaluate the predictors of HFpEF in acute STEMI patients during hospitalization, and Kaplan-Meier survival curve was used to compare the prognosis difference between 2 groups at 1 year after primary PCI. Results: The average age of 627 acute STEMI patients was(61.2±12.3) years. Compared with the pEF group, patients in the HFpEF group was older, less often male or current smokers, incidence of renal insufficiency and previous stroke were significantly higher, heart rate was higher and blood pressure was lower(all P<0.05). Multivariable logistic regression analysis showed that older age(OR=1.027), female sex(OR=2.052), previous stroke(OR=3.246), renal insufficiency(OR=2.001), higher heart rate(OR=1.030), and higher left ventricular end-diastolic dimension(LVEDd)(OR=1.074) were significantly associated with HFpEF in acute STEMI patients undergoing primary PCI during hospitalization(all P<0.05). The Kaplan-Meier survival analysis showed that the incidence of MACCE(19.0% vs. 5.3%, log-rank P<0.001) at 1 year after primary PCI was significantly higher in the HFpEF group than in the pEF group. Conclusions: In acute STEMI patients undergoing primary PCI, compared with the pEF group, the risk of MACCE is significantly increased in the HFpEF group. Older age, female sex, previous stroke, renal insufficiency, higher heart rate, and higher LVEDd are significantly associated with HFpEF during hospitalization in this patient cohort.更多还原