急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术后短期血压变异性与不良心血管事件的相关性

Correlation between short-term blood pressure variability after primary percutaneous coronary intervention and adverse cardiovascular events in patients with ST segment elevation myocardial infarction

  • 摘要: 目的 探讨行直接经皮冠状动脉介入治疗(PPCI)的急性ST段抬高型心肌梗死(STEMI)患者术后短期血压变异性(BPV)与术后1年不良心血管结局的相关性。方法 回顾性收集2016年1月1日至2019年1月31日于苏北人民医院心内科住院行PPCI并接受药物洗脱支架植入的STEMI患者临床及预后资料,共331例,分析术后0.5 h至3~4 d内BPV与患者术后1年不良心血管结局的相关性。采用血压标准差来评估个体收缩压变异性(SBPV)和舒张压变异性(DBPV)。根据人群SBPV和DBPV中位数(分别为11.42和8.49 mm Hg),定义高SBPV组为标准差≥11.42 mm Hg,高DBPV组为标准差≥8.49 mm Hg。运用多因素logistic回归模型探索SBPV及DBPV与术后1年主要不良心血管事件(MACE)的相关性。结果 与低SBPV组相比,高SBPV组心力衰竭发生率较高(21.1%比10.3%,χ2=7.264,P<0.05);而与低DBPV组相比,高DBPV组心力衰竭发生率(23.5%比7.9%,χ2=15.237)及累积MACE发生率(29.5%比13.9%,χ2=11.799)较高(均P<0.05);在校正年龄、性别、体质量指数(BMI)、降压药、左心室射血分数(LVEF)、Gensini评分等影响因子后,多因素二元logistic回归分析显示,高SBPV是心力衰竭(OR=3.462,95%CI 1.476~8.117,P=0.004)的危险因素,高DBPV是心力衰竭(OR=4.535,95%CI 1.725~11.926,P=0.002)及累积MACE (OR=3.412,95%CI 1.627~7.152,P=0.001)的危险因素。对使用口服降压药人群进行亚组分析,在校正年龄、性别、BMI、降压药、LVEF、Gensini评分等影响因子后,多因素二元logistic回归分析结果显示,高SBPV仍是心力衰竭(OR=4.328,95%CI 1.619~11.572,P=0.004)的危险因素,高DBPV仍是心力衰竭(OR=4.600,95%CI 1.518~13.934,P=0.007)及MACE(OR=4.942,95%CI 1.851~13.198,P=0.001)的危险因素。结论 行PPCI并接受药物洗脱支架植入的STEMI患者术后0.5 h至3~4 d内高BPV是其术后1年内MACE的危险因素。

     

    Abstract: Objective To investigate the relationship between short-term blood pressure variability(BPV) after primary percutaneous coronary intervention(PPCI) and adverse cardiovascular outcomes one year after operation in patients with acute ST segment elevation myocardial infarction(STEMI). Methods The clinical and prognostic data of 331 patients with STEMI who underwent PPCI and drug-eluting stent implantation were collected retrospectively in Cardiology Department of Subei People’s Hospital from January 1, 2016 to January 31, 2019. The correlation between blood pressure variability(BPV) and adverse cardiovascular outcome one year after operation was analyzed. Blood pressure standard deviation(SD) was used to evaluate individual systolic blood pressure variability(SBPV) and diastolic blood pressure variability(DBPV). According to the median of SD of systolic blood pressure(SBP) and diastolic blood pressure(DBP), the high SBPV group was defined as SD ≥11.42 mm Hg, while the high DBPV group was defined as SD ≥8.49 mm Hg. Multivariate bivariate logistic regression model was used to explore the correlation between SBPV, DBPV and major adverse cardiovascular events(MACE) 1 year after operation. Results Compared with the low SBPV group, the incidence of heart failure in the high SBPV group(21.1% vs 10.3%, χ~2=7.264) was significantly higher, while the incidence of heart failure(23.5% vs 7.9%, χ~2=15.237) and the cumulative incidence of MACE(29.5% vs 13.9%, χ~2=11.799) in the high DBPV group were higher than those in the low DBPV group(all P<0.05). After adjusting for age, sex, body mass index(BMI), antihypertensive drugs, left ventricular ejection fraction(LVEF), Gensini score and other influencing factors, multivariate binary logistic regression analysis showed that high SBPV was a risk factor for heart failure(OR=3.462, 95%CI 1.476-8.117, P=0.004), and high DBPV was a risk factor for heart failure and cumulative MACE(OR=4.535, 95%CI 1.725-11.926, P=0.002; OR=3.412, 95%CI 1.627-7.152, P=0.001, respectively). After adjusting for age, sex, BMI, antihypertensive drugs, LVEF, Gensini score and other influencing factors, multivariate binary logistic regression analysis showed that high SBPV was still a risk factor for heart failure(OR=4.328, 95%CI 1.619-11.572, P=0.004), as well as high DBPV for heart failure and cumulative MACE(OR=4.600, 95%CI 1.518-13.934, P=0.007; OR=4.942, 95%CI 1.851-13.198, P=0.001, respectively) in the subgroup hypertensives using oral antihypertensive drugs. Conclusion High BPV within 0.5 h to 3-4 days after PPCI and drug-eluting stent implantation in STEMI patients may be a risk factor for cardiovascular prognosis within 1 year after operation.

     

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