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目的:评估左心室舒张末期压力(LVEDP)对新发ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉(冠脉)介入治疗(PCI)后死亡率的影响。方法:该研究为回顾性分析。入选255例行急诊PCI的新发STEMI患者,术中均在冠脉血管开通前测量LVEDP,根据LVEDP的均值[14 mm Hg(1 mm Hg=0.133 k Pa)]分为LVEDP≤14 mm Hg组和LVEDP>14 mm Hg组,观察术后6个月死亡率。运用Cox回归分析LVEDP对死亡率的影响。结果:相对LVEDP≤14 mm Hg组,LVEDP>14 mm Hg组患者术后6个月死亡的风险比(HR)为4.26(P=0.03)。相关分析显示,LVEDP与左心室射血分数(r=-0.267,P=0.001)和B型利钠肽(r=0.154,P=0.041)呈轻度相关。多因素分析显示,在调整左心室射血分数及B型利钠肽后,LVEDP是术后6个月死亡的独立预测因素(每增加5 mm Hg,HR=1.22,P=0.04)。结论:急诊PCI术中测量的LVEDP是新发STEMI患者术后死亡的独立预测因素。
Objective: To evaluate the effect of left ventricular end-diastolic pressure (LVEDP) on mortality after emergency percutaneous coronary intervention (PCI) in patients with new-onset ST-segment elevation myocardial infarction (STEMI). Methods: This study was retrospectively analyzed. Two hundred and fifty-five patients with newly diagnosed STEMI undergoing PCI were enrolled. LVEDP was measured before the coronary artery was opened during operation. According to the mean LVEDP [14 mm Hg (1 mm Hg = 0.133 kPa)], the patients were divided into LVEDP≤14 mm Hg group And LVEDP> 14 mm Hg group. The mortality rate at 6 months after operation was observed. Cox regression was used to analyze the impact of LVEDP on mortality. RESULTS: The hazard ratio (HR) for death at 6 months after LVEDP> 14 mm Hg was 4.26 (P = 0.03) relative to LVEDP ≤ 14 mm Hg. Correlation analysis showed that LVEDP was slightly correlated with left ventricular ejection fraction (r = -0.267, P = 0.001) and type B natriuretic peptide (r = 0.154, P = 0.041) Multivariate analysis showed that LVEDP was an independent predictor of postoperative 6-month mortality (adjusted for 5 mm Hg, HR = 1.22, P = 0.04) after adjusting for left ventricular ejection fraction and B-type natriuretic peptide. CONCLUSIONS: LVEDP measured during emergency PCI is an independent predictor of postoperative death in newly diagnosed STEMI patients.