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目的观察行急诊经皮冠脉介入(PCI)治疗的急性心肌梗死患者入院即刻肌酐水平对短期和长期预后的影响。方法连续入选友谊医院心血管中心自2000年4月至2004年1月行急诊介入治疗的351例急性心肌梗死患者,按入急诊室即刻、PCI术前肌酐水平分组:Cr<133μmol/L为组1,Cr≥133μmol/L为组2。采用门诊和电话方式进行随访,平均随访(27.2±13.3)个月(6～51个月)。结果组2患者年龄明显高于组1(P<0.01),总胆固醇水平和低密度脂蛋白胆固醇水平均显著低于组1(P<0.05),C反应蛋白(CRP)水平明显高于组1(P<0.05),Killip分级水平显著高于组1(P<0.01),病变支数明显多于组1(P<0.05)。相关分析显示肌酐水平与以下因素有明显的相关性:年龄(相关系数0.203,P<0.01),性别(-0.106,P<0.01),总胆固醇(相关系数-0.134,P<0.05),低密度脂蛋白胆固醇(相关系数-0.12,P<0.05),高敏CRP(hs-CRP)(相关系数0.246,P<0.05),入院时中性粒细胞百分比(相关系数0.114,P<0.05),Killip分级(相关系数0.142,P<0.01),病变支数(相关系数0.137,P<0.05)。结论急性心肌梗死患者入院即刻肌酐水平的升高与年龄、hs-CRP、Killip分级及病变血管支数有显著相关性,是反映病变血管严重情况和心功能的有价值的指标,但与院内死亡和长期死亡相关性不明显。
Objective To investigate the effect of immediate creatinine on short-term and long-term prognosis in patients with acute myocardial infarction who underwent emergency percutaneous coronary intervention (PCI). Methods A total of 351 patients with acute myocardial infarction undergoing emergency interventional treatment at the Friendship Hospital Cardiovascular Center from April 2000 to January 2004 were randomly divided into emergency department and creatinine group before PCI: Cr <133μmol / L 1, Cr≥133μmol / L as group 2. Follow-up was conducted by outpatient and telephone interview, with an average follow-up of (27.2 ± 13.3) months (6 to 51 months). Results The age of group 2 was significantly higher than that of group 1 (P <0.01), the level of total cholesterol and low density lipoprotein cholesterol were significantly lower than those of group 1 (P <0.05), while the level of C-reactive protein (CRP) (P <0.05). The level of Killip was significantly higher than that of group 1 (P <0.01), and the number of lesions was more than that of group 1 (P <0.05). Correlation analysis showed that creatinine levels were significantly correlated with age (correlation coefficient 0.203, P <0.01), gender (-0.106, P <0.01), total cholesterol (correlation coefficient -0.134, P <0.05), low density CRP (hs-CRP) (correlation coefficient 0.246, P <0.05), the percentage of neutrophils on admission (correlation coefficient 0.114, P <0.05), Killip grading (Correlation coefficient 0.142, P <0.01), the number of lesions (correlation coefficient 0.137, P <0.05). Conclusions The elevation of creatinine immediately after admission in patients with acute myocardial infarction has a significant correlation with age, hs-CRP, Killip grade and vessel count. It is a valuable index to reflect the severity of vascular disease and cardiac function, but it is associated with death in hospital And long-term mortality was not obvious.