Risk factors and in-hospital prognosis of left ventricular thrombosis after acute STEMI
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摘要: 目的 探讨急性ST段抬高型心肌梗死(STEMI)后左心室血栓(LVT)形成的危险因素及其对院内预后的影响。 方法 选取2020年1月—2024年2月江苏省中医院收治的急性STEMI患者143例，根据是否合并LVT分为LVT组23例和非LVT组120例。比较两组患者基线资料、临床检验指标、超声心动图指标、冠状动脉造影情况及其住院期间主要不良心血管事件(MACE)，采用多因素logistic回归分析急性STEMI患者LVT形成的独立危险因素。 结果 多因素logistic回归分析显示，室壁瘤(OR=3.773，95%CI1.106~12.872，P=0.034)、Killip分级≥Ⅲ级(OR=5.914，95%CI1.731~20.202，P=0.005)、LVEF＜50%(OR=3.981，95%CI1.178~13.456，P=0.026)是急性STEMI患者LVT形成的独立危险因素。与非LVT组相比，LVT组MACE发生率显著增高(5.0% vs 34.8%，P＜0.001)。 结论 室壁瘤、LVEF＜50%及Killip分级≥Ⅲ级是急性STEMI患者LVT形成的独立危险因素；LVT可导致STEMI患者预后不良。
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关键词:
- 急性ST段抬高型心肌梗死 /
- 左心室血栓 /
- 危险因素 /
- 预后
Abstract: Objective To investigate the risk factors of left ventricular thrombosis(LVT) after acute ST-segment elevation myocardial infarction(STEMI) and its influence on hospital prognosis. Methods A total of 143 acute STEMI patients admitted to Jiangsu Province Hospital of Traditional Chinese Medicine from January 2020 to February 2024 were selected and divided into LVT group(23 cases) and non-LVT group(120 cases). Baseline data, clinical indicators, echocardiographic indicators, coronary angiography and major adverse cardiovascular events(MACE) during hospitalization were compared between the two groups. Multivariate logistic regression was used to analyze the independent risk factors for LVT formation in acute STEMI patients. Results Multivariate logistic regression analysis showed that ventricular aneurysm(OR=3.773, 95%CI1.106-12.872, P=0.034), Killip grade≥Ⅲ(OR=5.914, 95%CI1.731-20.202, P=0.005) and LVEF < 50%(OR=3.981, 95%CI1.178-13.456, P=0.026) were independent risk factors for LVT formation in acute STEMI patients. Compared with the non-LVT group, the incidence of MACE was significantly higher in the LVT group(5.0% vs 34.8%, P < 0.001). Conclusion Ventricular aneurysm, LVEF < 50% and Killip grade ≥Ⅲ are independent risk factors for LVT formation in acute STEMI patients. LVT can lead to poor prognosis in STEMI patients. -
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表 1 两组基线资料比较
Table 1. Baseline data and clinical test indexes
例(%), X±S 项目 LVT组(23例) 非LVT组(120例) P 年龄/岁 64.9±14.4 61.2±12.0 0.196 男性 19(82.6) 95(79.2) 0.926 高血压史 14(60.9) 87(72.5) 0.262 糖尿病史 8(34.8) 35(29.2) 0.591 高血脂史 3(13.0) 20(16.7) 0.902 脑卒中史 7(30.4) 17(14.2) 0.108 吸烟史 16(69.6) 59(49.2) 0.073 饮酒史 8(34.8) 23(19.2) 0.165 收缩压/mmHg△ 129.6±20.9 129.4±22.2 0.960 舒张压/mmHg 82.9±14.3 80.5±14.0 0.457 Killip分级 0.005 Ⅰ~Ⅱ级 16(69.6) 111(92.5) ≥Ⅲ级 7(30.4) 9(7.5) 心房颤动 6(26.1) 7(5.8) 0.007 心肌梗死部位 0.014 前壁 22(95.7) 86(71.7) 下壁或侧壁 1(4.3) 34(28.3) 阿司匹林 23(100.0) 120(100.0) P2Y12受体拮抗剂 23(100.0) 120(100.0) 替格瑞洛 18(78.3) 98(81.7) 氯吡格雷 5(21.7) 22(18.3) 肝素 23(100.0) 120(100.0) △1 mmHg=0.133 kPa 
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表 2 两组临床检验指标比较
Table 2. Clinical laboratory indicators
X±S, M(P25, P75) 项目 LVT组(23例) 非LVT组(120例) P 高敏肌钙蛋白I/(pg/mL) 7 600.0(1 804.5，26 673.0) 23 859.6(6 041.2，26 673.0) 0.195 超敏C反应蛋白/(mg/L) 12.5(4.1，28.7) 8.4(1.5，22.2) 0.321 血小板计数/(×109/L) 224.5±62.7 214.6±64.3 0.500 单核细胞/% 8.3±2.6 7.2±2.8 0.102 淋巴细胞/% 18.9±9.3 17.2±8.0 0.366 中性粒细胞/% 70.4±11.0 73.9±10.0 0.141 总胆固醇/(mmol/L) 4.6±1.5 4.61±1.24 0.948 甘油三酯/(mmol/L) 1.1(0.9，1.7) 1.5(1.1，2.2) 0.086 高密度脂蛋白胆固醇/(mmol/L) 1.3±0.4 1.2±0.3 0.055 低密度脂蛋白胆固醇/(mmol/L) 2.7(1.7，3.5) 2.6(2.1，3.3) 0.795 肌酸激酶/(U/L) 335.0(68.5，1 321.5) 846.0(213.3，1 5851.8) 0.108 肌酸激酶同工酶/(U/L) 31.0(12.5，167.5) 81.0(26.5，202.3) 0.050 乳酸脱氢酶/(U/L) 361.0(237.0，802.0) 480.5(323.3，748.8) 0.359 丙氨酸氨基转移酶/(U/L) 36.0(16.0，63.0) 39.0(23.0，61.8) 0.826 天冬氨酸氨基转移酶/(U/L) 57.0(23.0，234.0) 119.5(40.0，242.3) 0.325 血糖/(mmol/L) 6.1(4.8，7.9) 5.7(5.0，7.6) 0.577 尿酸/(μmol/L) 381.7±118.4 346.8±105.7 0.158 肌酐升高 4(17.4) 18(15.0) 0.774 D-二聚体升高 13(56.5) 59(49.2) 0.518 纤维蛋白原降解产物/(μg/mL) 2.9(1.7，7.1) 2.3(1.8，3.9) 0.732
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表 3 两组冠脉病变特点比较
Table 3. Characteristics of coronary artery lesions
例(%) 项目 LVT组(23例) 非LVT组(120例) P 病变血管数量 0.183 单支或双支 6(26.1) 49(40.8) 3支病变 17(73.9) 71(59.2) 犯罪血管分布情况 LM 1(4.3) 2(1.7) 0.411 LAD 22(95.7) 104(86.7) 0.385 LCX 13(56.5) 52(43.3) 0.245 RCA 12(52.2) 61(50.8) 0.906 冠脉全闭情况分布 LAD 14(60.9) 44(36.7) 0.030 LCX 2(8.7) 8(6.7) 1.000 RCA 4(17.4) 19(15.8) 1.000 既往PCI治疗史 1(4.3) 11(9.2) 0.724 冠脉狭窄：70%≤狭窄≤99%；冠脉全闭：管腔完全闭塞，无血流通过。LM：左主干；LCX：左回旋支；RCA：右冠脉。
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表 4 两组超声心动图检查结果比较
Table 4. The echocardiography results
例(%), X±S 项目 LVT组(23例) 非LVT组(120例) P LVEF/% 42.4±10.3 51.2±9.6 ＜0.001 LAD/mm 37.3±5.7 35.7±5.3 0.190 LVIDd/mm 51.0±6.2 49.8±5.9 0.377 LVIDs/mm 38.3±6.8 35.6±6.2 0.069 LVEF＜50% 19(82.6) 53(44.2) 0.001 室壁瘤 7(30.4) 10(8.3) 0.008
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表 5 LVT形成的危险因素logistic回归分析
Table 5. Risk factors of LVT formation analyzed by logistic regression analysis
变量 单因素 多因素 B OR(95%CI) P B OR(95%CI) P 室壁瘤 1.571 4.812(1.603~14.444) 0.005 1.328 3.773(1.106~12.872) 0.034 Killip分级≥Ⅲ级 1.686 5.396(1.764~16.507) 0.003 1.777 5.914(1.731~20.202) 0.005 LVEF＜50% 1.793 6.005(1.927~18.716) 0.002 1.382 3.981(1.178~13.456) 0.026 心房颤动 1.740 5.697(1.710~18.987) 0.005 LAD全闭 0.988 2.687(1.075~6.715) 0.034 前壁梗死 2.163 8.698(1.128~67.089) 0.038
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表 6 两组患者院内预后情况比较
Table 6. In-hospital prognosis
例(%) 项目 LVT组(23例) 非LVT组(120例) P MACE 8(34.8) 6(5.0) ＜0.001 急性左心衰竭 2(8.7) 2(1.7) 0.121 恶性心律失常 4(17.4) 4(3.3) 0.028 心源性休克 1(4.3) 0 0.161 心源性死亡 2(8.7) 0 0.025
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