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1、血运重建治疗对合并心力衰竭急性心肌梗死患者预后影响【摘要】目的探讨合并心力衰竭的急性心肌梗死患者的临床特征和预后，并分析影响其预后的因素。方法前瞻性连续纳入349例行急诊经皮冠脉介入治疗(PCI)的急性ST段抬高心肌梗死(STEMI)同时合并急性心力衰竭患者，按左室射血分数是否正常(定义为LVEF250%)将患者分为左室射血分数正常组(LVEFN50%,n=225)和左室射血分数降低组(LVEFV50%,n=124),分别评价患者住院期间的临床、血管造影、超声心动图等相关资料并对患者进行长期随访。平均随访时间为367d,一级终点为全因病死率。结果左室射血分数正常
2、组和左室射血分数降低组分别有4例(1.8%)和6例(4.8%)死亡，差异无统计学意义(P=0.314)O两组二级终点随访期间主要不良心脑血管事件差异具有统计学意义(P=0.022)oCox回归分析发现，患者心功能Killip分级水平(HR=1.092,95%CI：1.040〜1.149,P<0.01)是影响患者死亡的独立预测因子。结论影响行经皮冠状动脉介入治疗的急性心肌梗死合并心力衰竭患者的预后因素为患者心功能分级水平；左室射血分数正常组和左室射血分数降低组长期病死率相似。【关键词】血运重建；急性心肌梗死；心力衰竭；预后Effectofcoronaryrevas
3、cularizationontheprognosisofacutemyocardialinfarctionpatientscomplicatedwithheartfailureXUEZeng-ming,ANJu-hui,ZHAOZhi-gang,WANGXiao,NIEShao-ping,MAChang-sheng.DepartmentofCardiology,La.ngfa.ngPeople"sHospital,Langfang065000,ChinaCorrespondenceauthor：MAChang-sheng,Email：changshengmal2
4、3@126・com[Abstract]ObjectiveToexploretheclinicalcharacteristicsandprognosisofthepatientsofacutemyocardialinfarctioncomplicatedwithheartfailurebyanalyzingtheprognosticfactorsofthesepatients.MethodsThiswasasingle-centerprospectivestudyof349patientswithacuteheartfailureandECGdocumentedo
5、cuteSTelevatedmyocardialinfarction.AllpatientsweretreatedwithprimaryPCI.AfterPCI,clinical,angiographicandECGcharacteristics,andprognosisofthosewithpreserved(250%)orreduced(<50%)leftventricularejectionfraction(LVEF)wereassessed.Heartfailurepatientsweredividedintotwogroups：124withreduc
6、edEF(HFREF)and225withpreservedEF(HFPEF)・After367daysofaveragefollow-up,theprimaryoutcomeandnumberofdeathwererecorded.ResuItsOfthem,4(1.8%)patientsintheHFPEFgroupvs.6(4.8%)intheHFREFgroupdied.Thedifferenceinrateofdeathbetweentwogroupswasnotsignificant(P=0.314).Thereweresignifica.ntdif
7、ferenceinmainadversecardiacandcerebravascularevents(MACCE)occurredduringfollow-upperiodbetweenthetwogroups(P二0.022).TheKillipClassificationofheartfailure(HR二1.092,95%CI1.040〜1.149,P<0.01)wassignificantlyrelatedtothedeathrateduringfollow-up.ConclusionsTheindependentfactorsaffectin£pro
8、gnosisinpati
