目的 探讨急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性心肌梗死(acute myocardial infarction ,AMI)患者入院血浆尿酸(uric acid ,UA)水平对近期预后的影响。方法 400例行急诊PCI的AMI患者按血浆UA水平的75%分位数分为高UA组和低UA组,分别比较两组患者的一般临床资料、实验室和超声检查资料、冠状动脉造影资料及住院期间主要不良心脏事件(major adverse cardiac events ,MACE)的差异。采用Logistic多元回归分析对近期预后进行单因素和多因素分析,并应用Kaplan-Meier 法分析血浆UA水平对该类患者住院期间MACE发生率的影响。结果 400例中有101例在住院期间发生MACE,占25.25%;其中高UA组44例,占44.0%;低UA组57例,占19.0%。Logistic回归分析显示UA>395 μmol/L、Killip分级＞1、多支病变(≥两支冠状动脉病变)和LVEF<50%是AMI患者急诊PCI术后近期预后不良的独立预测因子。结论 AMI患者入院血浆UA水平与住院期间MACE发生率独立相关,提示高UA预后不良。
Abstract
Objective To evaluate the prognostic value of plasma levels of uric acid (UA) in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) . Methods A total of 400 patients with AMI who underwent primary PCI were divided into high UA group and low UA group on the basis of whether UA exceeded upper quartiles. The Baseline characteristics, laboratory findings, angiographic characteristics and major adverse cardiac events (MACEs) were compared between the two groups. Logistic multivariate regression analysis was used to assess the predictive value for in-hospital MACEs and the Kaplan-Meier method was applied in the MACE free survival rate analysis according to the levels of UA. Results 101 patients reported MACEs during ihospitalization. Multivariate forward stepwise Logistic regression analysis showed that UA>395 μmol/L, Killip class >1, multiple (≥double-vessel CAD) coronary arteries with stenosis and left ventricular ejection fraction <50% were independent predictors of subsequent MACEs. Conclusion The present study has showed that high levels of UA on admission are independently associated with in-hospital cardiovascular events in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.
关键词
急性心肌梗死 /
冠状动脉介入治疗 /
尿酸 /
预后
Key words
acute myocardial infarction /
percutaneous coronary intervention /
uric acid /
prognosis
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参考文献
[1] Bos M J,Koudstaal P J,Hofman A, et al. Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam study[J]. Stroke, 2006, 37 (6): 1503-1507.
[2] Strasak A M,Kelleher C C,Brant L J, et al. Serum uric acid is an independent predictor for all major forms of cardiovascular death in 28,613 elderly women: a prospective 21-year follow-up study[J]. Int J Cardiol, 2008, 125 (2): 232-239.
[3] Levantesi G,Marfisi R M,Franzosi M G, et al. Uric acid: A cardiovascular risk factor in patients with recent myocardial infarction[J]. Int J Cardiol, 2012, 16:34-36.
[4] Bickel C,Rupprecht H J,Blankenberg S, et al. Serum uric acid as an independent predictor of mortality in patients with angiographically proven coronary artery disease[J]. Am J Cardiol, 2002, 89 (1): 12-17.
[5] Akpek M,Kaya M G,Uyarel H, et al. The association of serum uric acid levels on coronary flow in patients with STEMI undergoing primary PCI[J]. Atherosclerosis, 2011, 219 (1): 334-341.
[6] Gazi E,Temiz A,Altun B,et al. The association between serum uric acid level and heart failure and mortality in the early period of ST-elevation acute myocardial infarction[J]. Turk Kardiyol Dern Ars, 2014, 42 (6): 501-508.
[7] Hajizadeh R,Ghaffari S,Salehi R, et al. Association of serum uric acid level with mortality and morbidity of patients with acute ST-elevation myocardial infarction[J]. J Cardiovasc Thorac Res, 2016, 8 (2): 56-60.
[8] Zhou C,Wu J, and Fang S. On-admission serum uric acid predicts outcomes after acute myocardial infarction[J]. Croat Med J, 2012, 53 (6): 642
[9] Liu C W. The association between serum uric acid and 1-year mortality in patients with ST-segment elevation myocardial infarction and chronic kidney disease: contrast-induced acute kidney injury and bleeding complications should be adjusted[J]. J Cardiovasc Med (Hagerstown), 2016, 17 (7): 538.
[10] Lazaros G,Tsiachris D,Aznaouridis K, et al. Uric acid in-hospital changes predict mortality in patients with acute myocardial infarction[J]. Nutr Metab Cardiovasc Dis, 2013, 23 (12): 1202-1209.
[11] Wang H,Li X,Zhang W, et al. Mechanism-based pharmacokinetic-pharmacodynamic modeling of salvianolic acid A effects on plasma xanthine oxidase activity and uric acid levels in acute myocardial infarction rats[J]. Xenobiotica, 2016, 12:1-9.
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