慢性阻塞性肺疾病对接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者住院期间发病率和死亡率的影响。
Impact of chronic obstructive pulmonary disease on in-hospital morbidity and mortality in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.
作者信息
Șerban Răzvan Constantin, Hadadi Laszlo, Șuș Ioana, Lakatos Eva Katalin, Demjen Zoltan, Scridon Alina
机构信息
University of Medicine and Pharmacy of Tîrgu Mureș, 540139 Tîrgu Mureș, Romania; Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania.
Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, 540136 Tîrgu Mureș, Romania.
出版信息
Int J Cardiol. 2017 Sep 15;243:437-442. doi: 10.1016/j.ijcard.2017.05.044. Epub 2017 May 11.
BACKGROUND
Patients with chronic obstructive pulmonary disease (COPD) presenting with ST-segment elevation myocardial infarction (STEMI) are less likely to beneficiate of primary percutaneous coronary intervention (pPCI), and have poorer prognosis. We aimed to evaluate the impact of COPD on the in-hospital outcomes of pPCI-treated STEMI patients.
METHODS
Data were collected from 418 STEMI patients treated by pPCI. Inotropics and diuretics usage, cardiogenic shock, asystole, kidney dysfunction, and left ventricular ejection fraction were used as markers of hemodynamic complications. Atrial and ventricular fibrillation, conduction disorders, and antiarrhythmics usage were used as markers of arrhythmic complications. In-hospital mortality was evaluated. The associations between these parameters and COPD were assessed.
RESULTS
COPD was present in 7.42% of STEMI patients. COPD patients were older (p=0.02) and less likely to receive beta-blockers (OR 0.29; 95%CI 0.13-0.64; p<0.01). They had higher Killip class on admission (p<0.001), received more often inotropics (p<0.001) and diuretics (p<0.01), and presented more often atrial (p=0.01) and ventricular fibrillation (p=0.02). Unadjusted in-hospital mortality was higher in COPD patients (OR 4.18, 95%CI 1.55-11.30, p<0.01). After adjustment for potentially confounding factors except beta-blockers, COPD remained an independent predictor of in-hospital mortality (p=0.02). After further adjustment with beta-blocker therapy, no excess mortality was noted in COPD patients.
CONCLUSIONS
Despite being treated by pPCI, COPD patients with STEMI are more likely to develop hemodynamic and arrhythmic complications, and have higher in-hospital mortality. This appears to be due to lower beta-blockers usage in COPD patients. Increasing beta-blockers usage in COPD patients with STEMI may improve survival.
背景
患有慢性阻塞性肺疾病（COPD）且出现ST段抬高型心肌梗死（STEMI）的患者接受直接经皮冠状动脉介入治疗（pPCI）的获益可能性较小，且预后较差。我们旨在评估COPD对接受pPCI治疗的STEMI患者院内结局的影响。
方法
收集了418例接受pPCI治疗的STEMI患者的数据。使用血管活性药物和利尿剂的使用情况、心源性休克、心搏骤停、肾功能不全以及左心室射血分数作为血流动力学并发症的指标。房性和室性心律失常、传导障碍以及抗心律失常药物的使用情况作为心律失常并发症的指标。评估院内死亡率。评估这些参数与COPD之间的关联。
结果
7.42%的STEMI患者患有COPD。COPD患者年龄较大（p = 0.02），接受β受体阻滞剂治疗的可能性较小（比值比0.29；95%置信区间0.13 - 0.64；p < 0.01）。他们入院时Killip分级较高（p < 0.001），更常使用血管活性药物（p < 0.001）和利尿剂（p < 0.01），房性心律失常（p = 0.01）和室性心律失常（p = 0.02）的发生率更高。COPD患者未经调整的院内死亡率较高（比值比4.18，95%置信区间1.55 - 11.30，p < 0.01）。在对除β受体阻滞剂外的潜在混杂因素进行调整后，COPD仍然是院内死亡率的独立预测因素（p = 0.02）。在进一步调整β受体阻滞剂治疗后，未发现COPD患者有额外的死亡率。
结论
尽管接受了pPCI治疗，但患有STEMI的COPD患者更有可能发生血流动力学和心律失常并发症，且院内死亡率较高。这似乎是由于COPD患者使用β受体阻滞剂较少。增加患有STEMI的COPD患者β受体阻滞剂的使用可能会改善生存率。
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