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摘要: 目的:分析急性ST段抬高型心肌梗死(STEMI)合并左室血栓形成(LVT)的危险因素,建立多重危险因素模型以定量评价各种因素对LVT的致病危险。方法:回顾性分析STEMI患者520例,分为LVT组48例和无LVT组472例。收集所有患者人口学特征和临床资料,建立STEMI合并LVT的多因素logistic回归模型。结果:前壁STEMI、前降支近段闭塞、多支或3支血管病变、左主干病变、左室室壁瘤(LVA)形成、左心室射血分数(LVEF)减低、白细胞升高、超敏C反应蛋白(hs-CRP)升高、平均血小板体积(MPV)升高、D-二聚体水平升高、纤维蛋白原(Fbg)升高等均为STEMI患者发生LVT的独立危险因素,其比值比(OR值)分别为17.92、22.37、7.08、8.12、22.41、7.18、1.56、1.52、1.48、1.98、1.42;而心肌梗死后12 h内就诊、冠脉侧支循环建立、既往有心绞痛病史均为STEMI患者发生LVT的独立保护因素,OR值依次为0.70、0.62、0.31、0.11。结论:前壁STEMI、前降支闭塞、多支或3支血管病变、左主干病变、室壁瘤形成、LVEF减低、白细胞升高、hs-CRP升高、MPV升高、D-二聚体水平升高、Fbg升高等均为STEMI患者发生LVT的独立危险因素,而心肌梗死后12 h内就诊、冠脉侧支循环建立、静脉药物溶栓和急诊PCI均为STEMI患者发生LVT的独立保护因素。心血管医生应该及早识别STEMI发生LVT的高危患者,积极干预可控因素,出院后规律行心脏彩超随访,及时发现LVT,改善STEMI预后。[JP]Abstract: Objective:To set up the multiple risk factors model of patients with anatomical left ventricular thrombus (LVT) post acute ST-elevation myocardial infarction (STEMI) and quantitatively assess the pathopoiesis of all the factors.Method:A total of 520 consecutive in-patients with acute STEMI were enrolled and divided into two groups: LVT group (n=48) and none-LVT group (n=472). All demographic and clinical data were collected by cardiologists. Finally, all of the risk factors for anatomical LVT in the acute STEMI patients were quantitatively analyzed by a binary logistic regression model.Result:The multiple risk factors logistic regression model was set up for the anatomical LVT in patients with acute STEMI. The independent risk factors of LVT in STEMI included anterior wall myocardial infarction, proximal occlusion of the left anterior descending branch, occlusion of left main artery, two or three vessels stenosis, left ventricular aneurysm, lower LV ejection fraction, white blood cell count over 10 000 per mocroliter, higher C-reactive protein, higher Mean platelet volume and higher D-dimer with the odds ration (OR) of 17.92, 22.37, 7.08, 8.12, 22.41, 7.18, 1.56, 1.52, 1.48 and 1.98, respectively (all P＜0.05). However, first medical contact less than 12 hours (OR=0.70), collateral circulation of the coronary arteries (OR=0.62), primary percutaneous coronary intervention (OR=0.11) and venous thrombolysis (OR=0.31) were all protecting factors of LVT in STEMI (all P＜0.05). Conclusion:It is important for cardiologists to assess the above-mentioned risk factors of LVT and take effective measures to reduce the risk of developing LVT in STEMI patients.
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Key words:
- myocardial infarction /
- left ventricular thrombus /
- risk factors
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[1] MIR J U,RAHEEL J J,ASFANDYAR Q,et al.Left ventricular thrombus in patients with acute anterior wall myocardial infarction[J].J Ayub Med Coll Abbottabad,2014,26:491-495.
[2] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗治疗[J].中华心血管管病杂志,2010,38(8):675-690.
[3] DALAL J,LOW L P,VAN PHUOC D,et al.The use of medications in the secondary prevention of coronary artery disease in the Asian region[J].Curr Med Res Opin,2015,11:1-11.
[4] 肖铁卉,王士雯,陈艳明,等.心肌梗死后室壁瘤合并附壁血栓形成的多因素分析[J].临床荟萃,2007,22(7):464-466.
[5] DELEWI R,ZIJLSTRA F,PIEK J J.Left ventricular thrombus formation after acute myocardial infarction[J].Heart,2012,98:1743-1749.
[6] GOYAL P,WEINSAFT J W.Cardiovascular magnetic resonance imaging for assessment of cardiac thrombus[J].Methodist Debakey Cardiovasc J,2013,9:132-136.
[7] DING S,ZHAO H,QIAO Z Q,et al.Early resolution of ST-segment elevation after reperfusion therapy for acute myocardial infarction:Its relation to echocardiography-determined left ventricular global and regional function and deformation[J].J Electrocardiol,2015,48:241-248.
[8] SHACHAM Y,LESHEM-RUBINOW E,BEN ASSA E,et al.Comparison of C-reactive protein and fibrinogen levels in patients having anterior wall STSegment elevation myocardial infarction with versus without left ventricular thrombus(from a primary percutaneous coronary intervention cohort)[J].Am J Cardiol,2013,112:57-60.
[9] SOLHEIM S,SELJEFLOT I,LUNDE K,et al.Prothrombotic markers in patients with acute myocardial infarction and left ventricular thrombus formation treated with pci and dual antiplatelet therapy[J].Thromb J,2013,11:1.
[10] ACAR Z,ZIYREK M,KORKMAZ L,et al.Mean platelet volume at admission is a determinant of left ventricular thrombus formation after primary percutaneous coronary intervention for first anterior wall myocardial infarction[J].Acta Cardiol,2014,69:603-609.
[11] SEROPIAN I M,TOLDO S,VAN TASSELL B W,et al.Anti-inflammatory strategies for ventricular remodeling following ST-segment elevation acute myocardial infarction[J].J Am Coll Cardiol,2014,63:1593-1603.
[12] DELEWI R,ZIJLSTRA F,PIEK J J.Left ventricular thrombus formation after acute myocardial infarction[J].Heart,2012,98:1743-1749.
[13] FIEDLER K A,BYRNE R A,SCHULZ S,et al.Rationale and design of The Intracoronary Stenting and Antithrombotic Regimen-Testing of a six-week versus a sixmonth clopidogrel treatment Regimen In Patients with concomitant aspirin and oraL anticoagulant therapy following drug-Eluting stenting(ISAR-TRIPLE)study[J].Am Heart J,2014,167:459-465.
[14] LE MAY M R,ACHARYA S,WELLS G A,et al.Prophylactic Warfarin Therapy After Primary Percutaneous Coronary Intervention for Anterior ST-Segment Elevation Myocardial Infarction[J].JACC Cardiovasc Interv,2015,8:155-162.
[15] GIANSTEFANI S,DOUIRI A,DELITHANASIS I,et al.Incidence and predictors of early left ventricular thrombus after ST-elevation myocardial infarction in the contemporary era of primary percutaneous coronary intervention[J].Am J Cardiol,2014,113:1111
[16] 孙王乐贤,刘会玲,张娜,等.急性ST段抬高型心肌梗死合并解剖性室壁瘤的多重危险因素分析[J].中华心血管病杂志,2015,43(1):51-55.
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