Page 39 - 中国全科医学2022-05

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PCI. Methods A total of 272 STEMI patients with initial LVEF ≥ 50% by transthoracic echocardiographic measurement
after being treated with primary PCI were selected from Heart Center，Hebei General Hospital from November 2016 to June
2018. All patients were admitted to the cardiovascular care unit following primary PCI. Data were collected，including baseline
characteristics（gender，smoking history，drinking history，family history of cardiovascular disease，angina in the past one
month，diabetes history，hypertension history，stroke history，old myocardial infarction，age，body mass index，pulse rate，
and mean arterial pressure），time of onset of chest pain〔including time from symptom onset to first medical contact，time from
symptom onset to first antiplatelet therapy，time from symptom onset to first anticoagulation，symptom onset to balloon time（SBT），
door-to-balloon（D-to-B） time〕，periprocedural data 〔pre-procedural TIMI flow grade，collateral circulation，treatment
of non-infarct related artery（NIRA），thrombus aspiration，IABP application，anticoagulant medication，pre-procedural
use of β-blockers，renin-angiotensin-aldosterone system inhibitors（RAASi），or statins，intra-procedural application of
tirofiban and prourokinase，post-procedure TIMI flow grade〕，laboratory test results（leukocyte count，Neutrophil count，
lymphocyte count，hemoglobin，hematocrit，platelet count，potassium ion，urea nitrogen，creatinine，random blood
glucose，eGFR，total cholesterol，triacylglycerol，high-density lipoprotein，low-density lipoprotein，very low-density
lipoprotein，non-high density lipoprotein，creatine kinase，creatine kinase isozyme） and transthoracic echocardiographic data.
The correlation between LVEF and in-hospital death was analyzed. By ROC analysis，the optimal threshold of LVEF predicting
in-hospital death was obtained，and patients with LVEF greater and less than the optimal threshold were compared in terms of
clinical indictors. Results The area under the ROC curve of LVEF predicting in-hospital death was 0.846〔95%CI（0.628，
1.000），P=0.018〕，and the optimal threshold was 67.5% with a sensitivity of 75.0% and a specificity of 95.1%. Compared with
those with LVEF <67.5%，patients with LVEF > 67.5% had higher in-hospital mortality〔18.8%（3/16） vs 0.4%（1/256）〕，
2
with a statistical difference（P<0.05）. Moreover，they also showed a statistical difference in Kaplan-Meier survival curve（χ =36.526，
P<0.001）. Furthermore，patients with LVEF > 67.5% showed higher female ratio and rate of IABP application，lower mean pulse
rate as well as lower rate of post-procedure TIMI grade 2-3 flow（P<0.05）. They also demonstrated lower mean left ventricular
end-systolic diameter（P<0.001）. Conclusion There may be a subgroup in STEMI patients with preserved ejection fraction after
primary PCI，who presented higher LVEF（supra-normal LVEF） and higher in-hospital mortality than those with normal LVEF.
The optimal threshold of LVEF for predicting in-hospital death in these STEMI patients was 67.5%. Being female and coronary
microcirculation disorder may contribute to the development of supra-normal ejection fraction.
【Key words】 ST Elevation myocardial infarction；Cardiovascular diseases；Left ventricular ejection fraction；
Echocardiography；Percutaneous coronary intervention；Microcirculation

左心室射血分数（left ventricular ejection fraction，
本研究价值：
LVEF）是临床常用的评估左心室收缩功能的指标，
本研究证实了急性 ST 段抬高型心肌梗死合并射
但在射血分数保留（>50%）的患者中 LVEF 与存活率
血分数保留患者中超常射血分数人群的存在，在国内
之间的关系仍未明确。以往研究关注点大多在射血分
首次提出超常射血分数的概念，并探讨了其可能机制，
数 降 低 的 心 力 衰 竭（heart failure with reduced ejection
为射血分数保留的心力衰竭提供了一定研究基础。
fraction，HFrEF）患者，其结果均显示 LVEF 与心力衰 本研究局限性：
竭患者的生存率呈负相关 ［1-5］ 。既往对 HFrEF 和射血
（1）本研究为单中心研究，存在一定的地域局
分数保留的心力衰竭（heart failure with preserved ejection
限性；（2）本研究对象为急性 ST 段抬高型心肌梗
fraction，HFpEF）的长期预后研究显示，两者长期死 死接受直接经皮冠状动脉介入术后的患者，不能代表
亡率无显著差异 ［6］ 。因此在 LVEF ≥ 50% 的人群中可
整个群体，仍需进一步纳入更多样本人群及其他病因
能仍存在一种临床表型，即合并超常射血分数人群，
患者。
影响 HFpEF 患者的临床预后。本文通过分析急性心肌
梗死患者接受直接经皮冠状动脉介入术（percutanneous 北省人民医院行直接 PCI 的急性 ST 段抬高型心肌梗死
coronary intervention，PCI） 术 后 LVEF>50% 人 群 中 患者 375 例，排除射血分数 <50% 的患者 101 例、数据
LVEF 与院内死亡的相关性，探索心肌梗死后超常射血 资料不全 2 例，最终 272 例患者纳入本研究。纳入标准：
［7］
分数患者的 LVEF 临界值及其可能机制。 （1）符合《急性 ST 段抬高型心肌梗死诊断和治疗指南》
1 资料与方法 的诊断标准；（2）发病至就诊在 12 h 内，行急诊冠状
1.1 一般资料 选取 2016 年 11 月至 2018 年 6 月在河 动脉造影，并行直接 PCI 治疗。排除标准：（1）未行