ST段抬高型心肌梗死合并射血分数降低心力衰竭患者接受二次PCI的原因及影响因素

The reasons and influencing factors of underwent secondary PCI in patients with ST-segment elevation myocardial infarction complicated by heart failure with reduced ejection fraction

摘要:

目的 针对ST段抬高型心肌梗死（STEMI）合并射血分数降低心力衰竭（HFrEF）患者的二次经皮冠状 动脉介入治疗术（PCI），结合临床特征和生物标志物分析二次PCI的原因和影响因素，为未来的干预策略提供方向。 方法 回顾性分析 2022年 1月至 2023年 7月在湛江中心人民医院医治的 295例 STEMI合并 HFrEF患者的临床资 料。统计接受二次PCI的原因，多因素logistic回归分析STEMI合并HFrEF患者二次PCI的影响因素。结果 接受 二次PCI的发生率为18.9%。接受二次PCI的原因分别是支架内再狭窄（32.1%）、发生新的冠状动脉病变（26.8%）、 多支血管病变（21.4%）、心律失常（8.9%）、心肌缺血（7.1%）、血栓形成（3.6%）。不完全血运重建、糖尿病病程 > 5 a、 入院 Gensini评分 > 100分、术后血管生成素Ⅱ是 STEMI合并 HFrEF患者接受二次 PCI的独立危险因素，而术后激 肽释放酶 1则是独立保护因素（P < 0.01或 0.05）。结论 接受二次 PCI的影响因素众多，支架内再狭窄是接受二次 PCI的最常见原因。

Abstract:

Objective To analyze the causes and influences of secondary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) combined with heart failure with reduced ejection fraction (HFrEF) in the context of clinical features and biomarkers, and to provide direction for future intervention strategies. Methods Statistical analysis of the reasons for underwent secondary PCI, and multiple logistic regression analysis of the influencing factors of underwent secondary PCI in patients with STEMI complicated by HFrEF. The acceptance of secondary PCI was subjected to statistical analysis to determine its reasons, and the influencing factors of secondary PCI in patients with STEMI and HFrEF were analyzed by multivariate logistic regression. Results The incidence of undergoing secondary PCI was 18.9%. The reasons for undergoing secondary PCI were as follows: stent restenosis (32.1%), new coronary artery disease (26.8%), multivessel disease (21.4%), arrhythmia (8.9%), myocardial ischemia (7.1%), and thrombosis (3.6%). Incomplete revascularization, diabetes duration > 5 years, admission Gensini score > 100, and postoperative angiopoietin II were identified as independent risk factors for undergoing secondary PCI in patients with STEMI complicated by HFrEF, while postoperative kallikrein-1 was an independent protective factor (P < 0.01 or P < 0.05). Conclusion There are many factors that can affect the undergoing secondary PCI,stent restenosis is the most common cause of underwent secondary PCI.