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目的:回顾性分析急性心肌梗死(AMI)患者住院行冠状动脉介入(PCI)治疗术后发生主要不良心脑血管事件(MACCE)及大出血的相关因素。方法:以2006年9月～2010年8月收住的280例AMI行PCI手术的患者为研究对象,分为病例组(包括MACCE组及大出血组)和对照组。搜集左室射血分数(LVEF)、血常规、血凝、肝肾功、血脂、血糖、心肌标志物等实验室数据以及球囊和支架扩张罪犯血管的部位、最高压力、时限、次数等指标,采用多因素Logistic回归的方法分析上述因素与MACCE及大出血的相关性。结果:与手术相关的多因素Logistic回归分析显示支架扩张最高压力与MACCE具有相关性(P<0.01);手术因素与大出血无任何相关。涵盖手术因素及实验室、病变及一般临床因素等多因素Logistic回归分析显示总胆固醇(TC)、心肌钙蛋白I(cTnI)、非弥漫性病变与MACCE具有相关性(P<0.05);而手术因素即支架扩张最高压力则失去了预测效能。与大出血具有相关性的指标是肌酐(Cr)、低密度脂蛋白胆固醇(LDL-C)、分叉病变、LVEF值(P<0.05)。结论:TC、cTnI、非弥漫性病变成为MACCE的相关因素。与手术因素相比TC、cTnI、非弥漫性病变对预测MACCE价值更大。而Cr、LDL-C、分叉病变、LVEF值成为大出血的相关因素。
OBJECTIVE: To retrospectively analyze the related factors of major adverse cardiovascular and cerebrovascular events (MACCE) and major bleeding in patients undergoing coronary intervention (PCI) after acute myocardial infarction (AMI). Methods: A total of 280 patients undergoing AMI with AMI admitted from September 2006 to August 2010 were enrolled in the study. Patients were divided into two groups: the MACCE group and the hemorrhage group, and the control group. Collect laboratory data such as left ventricular ejection fraction (LVEF), blood routine test, blood coagulation, liver and kidney function, blood lipid, blood glucose and myocardial markers as well as the location, maximum pressure, time limit and frequency of blood vessels of balloon and stent dilatation , The use of multivariate Logistic regression analysis of the above factors and MACCE and bleeding correlation. Results: Multivariate logistic regression analysis showed that the maximum pressure of stent dilation correlated with MACCE (P <0.01). There was no correlation between operative factors and major bleeding. The multivariate logistic regression analysis including surgical factors and laboratory, pathological and clinical factors showed that total cholesterol (TC), cardiac troponin I (cTnI) and non-diffuse lesions were correlated with MACCE (P <0.05) The factor that is the maximum stent expansion pressure is the loss of the predicted performance. Indicators of hemorrhage were creatinine (Cr), low density lipoprotein cholesterol (LDL-C), bifurcation lesion and LVEF (P <0.05). Conclusion: TC, cTnI and non-diffuse lesions are the related factors of MACCE. Compared with the surgical factors TC, cTnI, non-diffuse lesions on the value of MACCE prediction is greater. The Cr, LDL-C, bifurcation lesions, LVEF value as a major bleeding related factors.