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静息心率与行PCI治疗的急性心肌梗死合并心力衰竭患者远期预后的关系
作者:苗博1  李延鑫1  吴静1  薛玲玲2 
单位:1. 邢台市第三医院 心血管内科, 河北 邢台 054000;
2. 邢台医学高等专科学校, 河北 邢台 054000
关键词:静息心率 急性心肌梗死 心力衰竭 经皮冠状动脉介入术 预后 
分类号:R541.4;R541.61
出版年·卷·期(页码):2021·49·第五期(494-500)
摘要:

目的:探讨静息心率(RHR)对急性心肌梗死(AMI)合并心力衰竭(HF)接受经皮冠状动脉介入术(PCI)治疗患者远期预后的预测价值。方法:选取2013年8月至2014年8月邢台市第三医院心血管内科收治的AMI合并HF患者120例作为研究对象,根据入院即刻RHR水平≤73、74~81、82~90、≥91次·min-1将研究对象分为A、B、C、D 4组;所有患者随访5年,记录发生全因死亡和主要不良心血管事件(MACE)患者的信息;采用多因素Logistic回归分析筛选患者发生全因死亡和MACE的独立预测因素;采用Kaplan-Meier生存曲线分析4组全因死亡和发生MACE者的生存率;采用受试者工作特征曲线(ROC曲线)评价RHR对全因死亡和MACE的诊断价值。结果:多因素Logistic回归分析结果显示,年龄、血低密度脂蛋白胆固醇(LDL-C)水平、左心室射血分数(LVEF)、RHR及Gensini评分是全因死亡的独立预测因素;年龄、血LDL-C水平、LVEF、RHR、纽约心脏病协会(NYHA)心功能分级及Gensini评分是发生MACE的独立预测因子;4组患者全因死亡率和MACE发生率随RHR升高而增加(均P<0.05);在全因死亡中,4组患者心源性死亡差异有统计学意义(P<0.05),非心源性死亡差异无统计学意义(P>0.05),在发生MACE者中,4组患者心肌梗死发生率差异有统计学意义(P<0.05),其他差异无统计学意义(P均>0.05);Kaplan-Meier生存曲线显示,4组患者发生全因死亡和MACE的生存率差异有统计学意义(均P<0.05),D组生存率均明显低于A组和B组(均P<0.05)。ROC曲线显示,RHR对AMI合并HF患者PCI术后全因死亡的曲线下面积为0.872,最佳临界值为91次·min-1,MACE的曲线下面积为0.813,最佳临界值为86次·min-1,均具有较高的诊断价值。结论:RHR是AMI合并HF患者PCI治疗后远期发生全因死亡和MACE的独立预测因子,且诊断价值较高,具有临床参考作用。

Objective: To explore the value of resting heart rate(RHR)in predicting the long-term prognosis of patients with acute myocardial infarction(AMI) complicated with heart failure(HF) undergoing percutaneous coronary intervention(PCI). Methods: A total of 120 patients with AMI complicated with HF treated in the Department of Cardiology of Xingtai Third Hospitalbetween August 2013 and August 2014 were selected as subjects of our study. The subjects were divided into groups A, B, C and D based on RHR levels at admission: ≤ 73, 74-81, 82-90, and ≥ 91 times·min-1 respectively. All patients were followed up for 5 years, and information of all-cause death and MACE patients was recorded. Multivariate Logistic regression analysis was used to screen the independent predictors of all-cause death and major adverse cardiovascular events(MACE). The Kaplan-Meier survival curve was used to analyze the survival rates of all-cause death and MACE in four groups. The receiver working characteristic(ROC) curve was used to evaluate the prognosis of RHR and the diagnostic value of all-cause death and MACE.Results: Multivariate Logistic regression analysis showed that age, low density lipoprotein cholesterol(LDL-C), left ventricular ejection fraction(LVEF), RHR and Gensini score were independent predictors of all-cause death, while age, LDL-C level, LVEF, RHR, New York Heart Association(NYHA) cardiac function grade and Gensini score were independent predictors of MACE. The all-cause mortality and the incidence of MACE in the four groups increased with increasing RHR, and the effect was statistically significant(all P<0.05). For all-cause deaths, there was significant difference in cardiac death among the four groups(P<0.05), but no significant difference in non-cardiac death(P<0.05). In the occurrence of MACE, there was significant difference in the incidence of myocardial infarction among the four groups(P<0.05), but no significant difference in other MACE(all P<0.05). The Kaplan-Meier survival curve revealed significant differences in all-cause death and MACE survival rate among the four groups(all P<0.05). The survival rate in group D was significantly lower than that in group A and group B(P<0.05). The ROC curve showed that the area under the curve of RHR for AMI patients with HF after PCI was 0.872 and the optimal cut-off value was 91 times·min-1, while the area under the curve of MACE was 0.813 and the optimal cut-off value was 86 times·min-1, both of which had high diagnostic value.Conclusion: RHR is an independent predictor of long-term prognosis of all-cause death and MACE in patients with AMI combined with HF after PCI treatment, and has high diagnostic and clinical reference value.

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