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目的评价糖化血红蛋白(Hb A1c)对接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者长期预后的影响。方法入选2007年12月1日至2012年12月31日接受直接PCI的STEMI患者305例,记录患者的临床特点、Hb A1c等生化指标、随访期间死亡和主要不良心血管事件(MACE)发生情况,根据患者的Hb A1c值分为3组,组1(Hb A1c≤5.6%,85例)、组2(5.7%≤Hb A1c≤6.4%,117例)、组3(Hb A1c≥6.5%,103例)。结果临床随访平均(1 075±414)d,随访中死亡23例(7.5%),发生MACE 37例(12%)。1年内MACE发生率比较,组3(8.7%,9/103)明显高于组2(2.6%,3/117)和组1(1.2%,1/85;P=0.018);1年内死亡率比较,组3(5.8%,6/103)明显高于组2(0.9%,1/117)和组1(0%,0/85;P=0.010)。Hb A1c和长期(1年以上)MACE发生相关(P=0.015);多因素Cox回归分析,校正其他因素后,Hb A1c是长期(1年以上)死亡率的独立预测因子(HR:1.340,95%CI:1.099~1.633,P=0.004)。结论在接受直接PCI的STEMI患者,Hb A1c是1年及以上MACE发生及死亡的独立预测因子。
Objective To evaluate the long-term prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing direct percutaneous coronary intervention (PCI) with Hb A1c. Methods A total of 305 patients with STEMI undergoing direct PCI from December 1, 2007 to December 31, 2012 were enrolled in this study. The clinical characteristics, Hb A1c and other biochemical parameters were recorded. The incidence of death and major adverse cardiac events (MACE) during follow-up were recorded (Hb A1c≤5.6%, 85 cases), group 2 (5.7% ≤Hb A1c≤6.4%, 117 cases), group 3 (Hb A1c≥6.5%, 103 cases). Results The average clinical follow-up was (1075 ± 414) d, with 23 deaths (7.5%) at follow-up and 37 (12%) MACEs. The incidence of MACE within 1 year was significantly higher in group 3 (8.7%, 9/103) than in group 2 (2.6%, 3/117) and group 1 (1.2%, 1/85; P = 0.018) Group 3 (5.8%, 6/103) was significantly higher than Group 2 (0.9%, 1/117) and Group 1 (0%, 0/85; P = 0.010). Hb A1c was associated with long-term (more than 1 year) MACE (P = 0.015). After multivariate Cox regression analysis, Hb A1c was an independent predictor of long-term (1-year) mortality after adjusting for other factors (HR 1.340, % CI: 1.099-1.633, P = 0.004). Conclusions Hb A1c is an independent predictor of the occurrence and death of MACEs at 1 year and over in STEMI patients undergoing direct PCI.