经皮冠状动脉介入治疗联合主动脉球囊反搏治疗急性心肌梗死合并心功能不全预后的危险因素分析

Analysis of Prognostic Risk Factors of Patients with Acute Myocardial Infarction Complicated with Cardiac Insufficiency Treated by Percutaneous Coronary Intervention Combined with Intra-Aortic Balloon Counterpulsation

摘要: 目的：探讨影响应用主动脉内球囊反搏(IABP)联合经皮冠状动脉介入术(PCI)治疗急性心肌梗死(AMI)合并心功能不全患者死亡的危险因素。方法：回顾性收集2012年6月至2021年6月由青岛大学附属医院被诊断为AMI合并心功能不全并行PCI + IABP置入的52例患者临床资料，根据PCI + IABP治疗后12个月生存情况分为存活组32例和死亡组20例。统计并比较两组患者基线资料、冠状动脉造影及介入治疗相关指标，包括既往史、血压、心率、血脂、血糖、病变血管、梗死部位、心肌梗死溶栓治疗临床试验(TIMI)血流分级等，分析患者PCI + IABP治疗后预后不良的独立影响因素。结果：52例患者死亡患者20例，存活患者32例，其中死亡组的血糖含量显著高于存活组，而存活组的血压，无论是收缩压还是舒张压均明显高于死亡组，同时死亡组出现三支病变和术前TIMI血流 < 3级所占比例显著高于存活组。单因素和多因素Logistic回归分析显示，术前TIMI血流分级是应用PCI联合IABP治疗的AMI伴心功能不全患者死亡的独立危险因素。结论：术前TIMI血流分级是影响应用PCI联合IABP治疗的AMI合并心功能不全患者近远期预后的独立危险因素，临床对于经皮冠状动脉介入治疗(PCI)前TIMI低级别患者应加强监护，积极采取补救措施以改善患者预后。

Abstract: Objective: To investigate the risk factors of death in patients with acute myocardial infarction (AMI) complicated with cardiac insufficiency treated with intra aortic balloon counterpulsation (IABP) combined with percutaneous coronary intervention (PCI). Methods: The clinical data of 52 patients with AMI complicated with cardiac insufficiency who received PCI + IABP implantation treatment in the Affiliated Hospital of Qingdao University, from June 2012 to June 2021 were collected retrospec-tively. According to the 12-month survival after PCI + IABP treatment, they were divided into sur-vival group and death group. The baseline data, coronary angiography and interventional therapy related indexes of the two groups were counted, including previous history, blood pressure, heart rate, blood lipid, blood glucose, diseased vessels, infarct location, TIMI blood flow classification, etc. And the independent influencing factors of poor prognosis after PCI + IABP treatment were ana-lyzed. Results: Among the 52 patients, 20 died and 32 survived. The blood glucose content in the death group was significantly higher than that in the survival group, while the blood pressure, whether systolic or diastolic, in the survival group was significantly higher than that in the death group. At the same time, the proportion of three vessel lesions and preoperative TIMI blood flow < 3 in the death group was significantly higher than that in the survival group. Univariate and multi-variate logistic regression analysis showed that preoperative TIMI blood flow classification was an independent risk factor for death in AMI patients with cardiac insufficiency treated with PCI com-bined with IABP. Conclusion: Preoperative TIMI blood flow classification is an independent risk fac-tor affecting the short-term and long-term prognosis of AMI patients with cardiac insufficiency treated by PCI combined with IABP. Clinically, we should strengthen the monitoring of low-grade TIMI patients before percutaneous coronary intervention (PCI) and actively take remedial measures to improve the prognosis of patients.