ST段抬高型心肌梗死患者接受直接经皮冠状动脉介入治疗时的年龄、心肌灌注受损与死亡率

Ageing, impaired myocardial perfusion, and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty.

作者信息

De Luca Giuseppe, van 't Hof Arnoud W J, Ottervanger Jan Paul, Hoorntje Jan C A, Gosselink A T Marcel, Dambrink Jan-Henk E, de Boer Menko-Jan, Suryapranata Harry

机构信息

Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Groot Weezelanden 20, 8011 JW Zwolle, The Netherlands.

出版信息

Eur Heart J. 2005 Apr;26(7):662-6. doi: 10.1093/eurheartj/ehi110. Epub 2005 Jan 28.

DOI:10.1093/eurheartj/ehi110

PMID:15681574

Abstract

AIMS

It is still unknown whether impaired myocardial perfusion helps to explain the higher mortality observed with ageing in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty.

METHODS AND RESULTS

In 1548 consecutive patients with STEMI treated with primary angioplasty, myocardial perfusion was evaluated by myocardial blush grade (MBG) and ST-segment resolution. All clinical and follow-up data were prospectively collected. Advanced age was associated with a significantly higher clinical and angiographic risk profile. We found a linear relationship between increasing age, decreased myocardial perfusion, and higher 1-year mortality. After adjustment for baseline potential confounding variables, increased age was still significantly associated with impaired myocardial blush (MBG 0-1) (P=0.028), and ST-segment resolution (<50%) (P=0.007). At multivariable analysis both age (P<0.0001) and poor myocardial perfusion (P<0.0001) were independent predictors of 1-year mortality.

CONCLUSION

This study shows that impaired reperfusion is an additional determinant of the poor outcome observed with advanced age in patients with STEMI undergoing mechanical revascularization.

摘要

目的

对于接受直接血管成形术治疗的ST段抬高型心肌梗死（STEMI）患者，心肌灌注受损是否有助于解释随着年龄增长所观察到的较高死亡率，目前仍不清楚。

方法与结果

在1548例接受直接血管成形术治疗的连续性STEMI患者中，通过心肌 blush 分级（MBG）和ST段回落情况评估心肌灌注。所有临床和随访数据均前瞻性收集。高龄与显著更高的临床和血管造影风险特征相关。我们发现年龄增加、心肌灌注降低与1年死亡率升高之间存在线性关系。在对基线潜在混杂变量进行校正后，年龄增加仍与心肌 blush 受损（MBG 0 - 1）（P = 0.028）和ST段回落（<50%）（P = 0.007）显著相关。在多变量分析中，年龄（P < 0.0001）和心肌灌注不良（P < 0.0001）均为1年死亡率的独立预测因素。