左心室功能降低的急性心肌梗死患者中肺动脉高压的列线图预后价值
Prognostic value of pulmonary hypertension with a nomogram in acute myocardial infarction patients with reduced left ventricular function.
作者信息
Liu Qian, Zhao Changying, Dang Peizhu, Li Yongxin, Yan Yang
机构信息
Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
出版信息
Front Cardiovasc Med. 2024 Apr 22;11:1368139. doi: 10.3389/fcvm.2024.1368139. eCollection 2024.
BACKGROUND
Pulmonary hypertension (PH) is a common prognostic factor for acute myocardial infarction (AMI) and its impact may increase when combined with reduced left ventricular function.
METHODS
This retrospective cohort study enrolled AMI patients with reduced left ventricular function at the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to January 2022. Basing on the systolic pulmonary artery pressure assessed by echocardiogram, patients were assigned to the PH group and control group. Propensity score matching (PSM) in sex, age and Killip classification was used to match patients between two groups. The primary outcome was defined as 1-year mortality rate, which were obtained from medical records and phone calls.
RESULTS
After the PSM, a total of 504 patients were enrolled, with 252 in both groups. No significant difference of the adjusted factors was observed between the two groups. The 1-year mortality rate was significantly higher in the PH group compared with the control group (15.5% vs. 5.3%, < 0.001). In the cox regression analysis, PH (HR: 2.068, 95% CI: 1.028-4.161, = 0.042) was identified as an independent risk factor, alongside left ventricular ejection fraction (HR: 0.948; 95% CI: 0.919-0.979; < 0.001), creatine kinase-MB isoenzymes (HR: 1.002; 95% CI: 1.000-1.003; = 0.010) and pro-brain natriuretic peptide (HR: 1.000; 95% CI: 1.000-1.000; = 0.018) for the 1-year mortality in AMI patients with reduced left ventricular function. A nomogram was established using the above factors to predict the 1-year mortality risks in these patients.
CONCLUSION
AMI patients with reduced left ventricular function showed higher 1-year mortality rate when concomitant with PH. Four independent risk factors, including PH, were identified and used to establish a nomogram to predict the 1-year mortality risks in these patients.
CLINICAL TRIALSGOV ID
NCT06186713.
背景
肺动脉高压（PH）是急性心肌梗死（AMI）常见的预后因素，当合并左心室功能减退时其影响可能会增加。
方法
这项回顾性队列研究纳入了2018年1月至2022年1月在西安交通大学第一附属医院就诊的左心室功能减退的AMI患者。根据超声心动图评估的收缩期肺动脉压，将患者分为PH组和对照组。采用倾向评分匹配（PSM）在性别、年龄和Killip分级方面对两组患者进行匹配。主要结局定义为1年死亡率，通过病历和电话随访获得。
结果
PSM后，共纳入504例患者，每组252例。两组间调整因素无显著差异。PH组的1年死亡率显著高于对照组（15.5%对5.3%，<0.001）。在多因素Cox回归分析中，PH（HR：2.068，95%CI：1.028 - 4.161，P = 0.042）被确定为独立危险因素，同时左心室射血分数（HR：0.948；95%CI：0.919 - 0.979；<0.001）、肌酸激酶-MB同工酶（HR：1.002；95%CI：1.000 - 1.003；P = 0.010）和脑钠肽前体（HR：1.000；95%CI：1.000 - 1.000；P = 0.018）也是左心室功能减退的AMI患者1年死亡率的独立危险因素。利用上述因素建立了列线图，以预测这些患者的1年死亡风险。
结论
左心室功能减退的AMI患者合并PH时1年死亡率较高。确定了包括PH在内的四个独立危险因素，并用于建立列线图以预测这些患者的1年死亡风险。
临床试验注册号
NCT06186713。
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