Long-term prognosis and predictors of left ventricular ejection fraction recovery in patients with ST-segment elevation myocardial infarction and mid-range ejection fraction
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摘要: 目的:本研究针对左室射血分数(LVEF)恢复对ST段抬高型心肌梗死(STEMI)合并射血分数中间值(mrEF)患者的预后进行分析,并探索LVEF恢复的独立影响因素。方法:连续性收集2017年1月—2019年12月于河北省人民医院确诊为急性STEMI行直接经皮冠状动脉介入(PCI)治疗的患者,并将术后3 d内首个超声心动图测得的LVEF在40%~49%的患者纳入研究。随访PCI术后3个月时的LVEF,依据基线至3个月时LVEF是否恢复至50%分为恢复组(79例)和未恢复组(28例)。通过住院电子病历系统采集患者的临床资料,电话和门诊随访患者的长期预后,包括全因死亡、心肌梗死、因心力衰竭住院、血运重建和脑卒中事件,随访时间截止至2020年12月31日。结果:生存分析显示,包含全因死亡、心肌梗死、因心力衰竭住院、血运重建和脑卒中的复合终点累积事件发生率在未恢复组显著高于恢复组(P=0.002),LVEF恢复是复合终点的独立预测因子(HR2.55,95%CI1.03~6.29,P=0.043)。Logistic回归显示,肌酸激酶同工酶(CK-MB)峰值、氨基末端脑钠肽前体(NT-proBNP)峰值、基线LVEF、总缺血时间是STEMI伴mrEF患者LVEF恢复的独立影响因素(P<0.05)。结论:STEMI伴mrEF患者的LVEF恢复可显著降低不良预后的发生风险。CK-MB峰值、NT-proBNP峰值、基线LVEF和总缺血时间是LVEF恢复的独立影响因素。
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关键词:
- ST段抬高型心肌梗死 /
- 射血分数中间值 /
- 左室射血分数恢复
Abstract: Objective: To evaluate the impact of left ventricular ejection fraction(LVEF) recovery in patients with mid-range ejection fraction(mrEF) after ST-segment elevation myocardial infarction(STEMI), and further explored the independent factors of LVEF recovery.Methods: Patients with LVEF between 40% and 49% after primary percutaneous coronary intervention(PCI) were consecutively enrolled. LVEF was measured by echocardiography within 3 days and 3 months after PCI. Patients were divided into the recovery group(79 patients) and no-recovery group(28 patients) according to whether LVEF recovered to 50% from baseline to 3 months after PCI. The clinical data of patients was collected through the electronic medical record system. Long-term outcomes of patients including all-cause death, myocardial infarction, revascularization, hospitalization for heart failure, and stroke were followed up.Results: The results of survival analysis showed that the cumulative event rate of the composite endpoint(all-cause death, myocardial infarction, revascularization, hospitalization for heart failure, and stroke) in the no-recovery group was significantly higher than that in the recovery group(P=0.002). LVEF recovery was independently associated with the composite endpoint(HR2.55, 95%CI1.03-6.29, P=0.043). Logistic regression found that peak CK-MB, peak NT-proBNP, baseline LVEF, and total ischemic time were independent factors of LVEF recovery in STEMI patients with mrEF(P<0.05).Conclusion: LVEF recovery is independently associated with the reduced risk of poor prognosis in STEMI patients with mrEF. Peak CK-MB, peak NT-proBNP, baseline LVEF and total ischemic time are independent factors. -
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