The efficiency of CAMI-NSTEMI Score in assessing stenosis severity of culprit artery in NSTEMI patients
-
摘要: 目的:研究罪犯血管TIMI分级为闭塞病变相关的独立影响因子,探索CAMI-NSTEMI评分与非ST段抬高型心肌梗死(NSTEMI)患者罪犯血管狭窄程度的相关性。方法:回顾性入选2016年1月-2018年12月期间贵州医科大学附属医院行经皮冠状动脉介入治疗(PCI)的NSTEMI患者211例,分为罪犯血管闭塞组(TIMI≤1)和非闭塞组(TIMI≥2),分析一般资料,采用多因素二分类Logistic回归模型分析罪犯血管闭塞的独立危险因素。分别以首次医疗接触(FMC)至PCI时长和CAMI-NSTEMI评分为标准,分为早期组(≤24 h)、延迟组(>24 h)和低危(≤79)、中危(80~101)、高危(≥102)3组,分析病变血管支数、罪犯血管的部位和狭窄程度。结果:NSTEMI患者的既往PCI史、肌钙蛋白峰值、脑钠肽(BNP)是罪犯血管闭塞的独立危险因素(P<0.05)。早期PCI和延迟PCI两组的病变血管支数、罪犯血管的分布及狭窄程度差异无统计学意义(P>0.05)。CAMI-NSTEMI评分低、中、高3组的病变血管支数、罪犯血管的分布差异亦无统计学意义(P>0.05)。CAMI-NSTEMI评分中、高危组罪犯血管的狭窄程度均高于低危组,差异有统计学意义(P<0.05)。而中、高危组间罪犯血管狭窄程度的差异无统计学意义(P>0.05)。结论:既往PCI史、肌钙蛋白、BNP均为NSTEMI患者罪犯血管闭塞的独立危险因子。CAMI-NSTEMI评分可以帮助临床早期对NSTEMI患者罪犯血管的狭窄程度进行评估。
-
关键词:
- 非ST段抬高型心肌梗死 /
- 罪犯血管 /
- TIMI血流分级 /
- CAMI-NSTEMI评分 /
- 狭窄程度 /
- GRACE评分
Abstract: Objective:To investigate the correlation of CAMI-NSTEMI Score and the culprit artery stenosis severity in NSTEMI patients and to study the independent factors of occlusive culprit artery.Method:This retrospective study includes 211 NSTEMI patients,accepted percutaneous coronary intervention(PCI) following the China Guidelines for diagnosis and treatment of non-ST-segment elevated acute coronary syndrome(2016) in The Affiliated Hospital of Guizhou Medical University from January 2016 to December 2018.All divided into two groups with the TIMI-flow of culprit artery,as occlusive group(TIMI≤1) and non-occlusive group(TIMI≥2).We compare the two group's data including general clinical characters,blood markers,Killip rank,LVEF,the time from First Medical Contact to PCI,CAMI-NSTEMI score and GRACE score.A multivariate binary logistic regression analyzed the independent risk factors of criminal vascular occlusion.All patients divided into early-PCI group(≤24 h) and delay-PCI group(>24 h) based on the time of First Medical Contact(FMC) to PCI.They also divided into low risk(≤79),middle risk(80-101) and high risk(≥102),based on CAMI-NSTEMI score.We analyzed the number of lesion coronary vessels,the culprit artery distribution and the stenosis severity.Result:The history of PCI,the peak of cardio troponin and BNP,were independent risk factors of occlusive culprit artery in NSTEMI patients(P<0.05).There were no differences in the number of lesion coronary vessels,the distribution and the stenosis severity of culprit artery between the early-PCI and delay-PCI groups(P>0.05).There were no difference in the number of lesion coronary vessels and the culprit artery distribution among high,middle and low risk groups(P>0.05).But the percentage of culprit artery stenosis were higher in both high and middle risk groups than in low risk group(P<0.05).Conclusion:The history of PCI,cardio troponin and BNP are independent risk factors of occlusive culprit artery in NSTEMI patients. -
-
[1] Fu R,Song C,Yang J,et al.CAMI-NSTEMI Score-China Acute Myocardial Infarction Registry-Derived Novel Tool to Predict In-Hospital Death in Non-ST Segment Elevation Myocardial Infarction Patients[J].Circ J,2018,82(7):1884-1891.
[2] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[3] Timmis A.Acute coronary syndromes[J].BMJ,2015,351:5153-5153.
[4] Yao Y,Liu G,Wang L,et al.Disease and disparity in China:a view from stroke and MI disease[J].Int J Equity Health,2019,18(1):85-85.
[5] Yeh RW,Sidney S,Chandra M,et al.Population trends in the incidence and outcomes of acute myocardial infarction[J].N Engl J Med,2010,362(23):2155-2165.
[6] O'Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].Circulation,2013,127:e362-e425.
[7] Puymirat E,Simon T,Cayla G,et al.Acute myocardial infarction:changes in patient characteristics,management,and 6-month outcomes over a period of 20 years in the FAST-MI program (French registry of acute ST-elevation or non-ST-elevation myocardial infarction) 1995 to 2015[J].Circulation,2017,136(20):1908-1919.
[8] Neumann FJ,Sousa-Uva M,Ahlsson A,et al.2018 ESC/EACTS Guidelines on myocardial revascularization[J].Eur Heart J.2019,40(2):87-165.
[9] Khan AR,Golwala H,Tripathi A,et al.Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction:a systematic review and meta-analysis[J].Eur Heart J,2017,38(41):3082-3089.
[10] 朱红涛,邱林林,李斌义,等.冠状动脉急性完全闭塞的不典型心电图分析[J].临床心血管病杂志,2017,33(9):870-874.
[11] Bailleul C,Aissaoui N,Cayla G,et al.Prognostic impact of prepercutaneous coronary intervention TIMI flow in patients with ST-segment and non-ST-segment elevation myocardial infarction:Results from the FAST-MI 2010 registry[J].Arch Cardiovasc Dis,2018,111(2):101-108.
[12] 朱红涛,邱林林,李斌义,等.冠状动脉急性完全闭塞的不典型心电图分析[J].临床心血管病杂志,2017,33(9):870-874.
[13] 梁少兰,靳文,杜作义,等.hs-CRP、BNP及D-二聚体与ACS近期不良心血管事件的关系[J].临床心血管病杂志,2014,30(7):583-585.
[14] Kim JY,Kim KH,Cho JY,et al.D-dimer/troponin ratio in the differential diagnosis of acute pulmonary embolism from non-ST elevation myocardial infarction[J].Korean J Intern Med,2019,34(6):1263-1271.
[15] 姜琳,宋莹,许晶晶,等.左心室射血分数小于50%的冠心病患者行冠状动脉介入治疗的预后[J].中华心血管病杂志,2017,45(12):1058-1066.
[16] 曹娟,金雪娟,周俊,等.N末端B型利钠肽原对射血分数保留的心力衰竭患者全因死亡的预测价值[J].中华心血管病杂志,2019,47(11):875-881.
[17] 刘璇,李树仁,杨国慧.胸痛中心模式下急性ST段抬高型心肌梗死救治现状研究[J].临床心血管病杂志,2019,35(5):420-424.
-
计量
- 文章访问数: 188
- PDF下载数: 86
- 施引文献: 0
下载: