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Relationship between thrombolysis in myocardial infarction risk index and the severity of coronary artery lesions and long-term outcome in acute myocardial infarction patients undergoing percutaneous coronary intervention



Relationship between thrombolysis in myocardial infarction risk index and the severity of coronary artery lesions and long-term outcome in acute myocardial infarction patients undergoing percutaneous coronary intervention



Zhonghua Xin Xue Guan Bing Za Zhi 46(11): 874-881



目的: 探讨心肌梗死溶栓危险指数(TRI)与急性心肌梗死(AMI)患者冠状动脉病变严重程度及介入治疗远期预后的关系。 方法: 采用前瞻性研究方法,连续纳入2013年1至12月在阜外医院接受经皮冠状动脉介入治疗(PCI)的AMI患者1 663例。冠状动脉病变的严重程度通过SYNTAX评分评估。采用受试者工作特征(ROC)曲线分析TRI预测PCI术后2年全因死亡的最佳截断值。根据最佳截断值(23.05),将AMI患者分为高TRI组(TRI≥23.05,465例)和低TRI组(TRI<23.05,1 198例)。采用多因素logistic回归分析TRI与SYNTAX评分≥33分的相关性。采用Cox比例风险回归模型分析PCI术后远期预后的影响因素。 结果: 高TRI组患者的SYNTAX评分高于低TRI组[13.00(7.00,20.50)分比10.25(7.00,17.00)分,P< 0.001]。多因素logistic回归分析显示,TRI与SYNTAX评分≥33分独立相关(OR=1.09,95% CI 1.03~1.16,P=0.004)。术后2年,高TRI组全因死亡[4.1%(19/465)比0.3%(4/1 198),P< 0.001]、心原性死亡[2.6%(12/465)比0.2%(2/1 198),P< 0.001]和支架内血栓形成[1.7%(8/465)比0.5%(6/1 198),P=0.015]发生率均高于低TRI组。多因素Cox回归分析显示,TRI≥23.05是AMI患者PCI术后2年全因死亡(HR=5.22,95%CI 1.63~16.72,P=0.005)、心原性死亡(HR=8.48,95%CI 1.75~41.07,P=0.008)和支架内血栓形成(HR=3.87,95%CI 1.32~11.41,P=0.014)的独立危险因素,不是术后2年严重不良心脑血管事件的独立危险因素(HR=0.96,95%CI 0.69~1.36,P=0.834)。TRI≥23.05预测AMI患者PCI术后2年全因死亡的ROC曲线下面积为0.803(95%CI 0.711~0.894,P< 0.001)。 结论: TRI与SYNTAX评分≥33分独立相关;高TRI是AMI患者PCI术后2年全因死亡、心原性死亡和支架内血栓形成的独立危险因素。.

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