姚朱华 1陈湾湾 2曹明英 1李永斌 1高雪梅 1王静 1尹浩晔1
作者信息
- 1. 300121 天津市人民医院心内科
- 2. 天津医科大学研究生院
- 折叠
摘要
Abstract
Objective To observe the clinical efficacy and safety of rhPro-UK in the treatment of ST -segment elevation myocardial infarction ( STEMI) and analyze the risk factors for in-hospital bleeding.Methods A total of 87 patients with STEMI after thrombolytic therapy with rhPro-UK in CCU of Tianjin People′s Hospital from May 2013 to March 2015 who accorded with the inclusion and exclusion criteria were enrolled.According to the score of the Global Registry of Acute Coronary Events (GRACE), we divided the patients into GRACE low-risk group (GRACE<109, 45 cases), GRACE mid-risk group (GRACE 109~140, 29 cases) and GRACE high -risk group ( GRACE >140, 13 cases) .According to Thrombolysis in Myocardial Infarction (TIMI) risk score, we divided the patients into TIMI low-risk group (TIMI 0~3, 49 cases), TIMI mid-risk group ( TIMI 4 ~6, 24 cases) and TIMI high -risk group ( TIMI≥7, 14 cases) .30, 60, 90, 120 min after thrombolytic therapy, the coronary recanalization rates were observed and compared among patients with different time from onset to thrombolytic therapy.The incidence of bleeding and major adverse cardiac events ( MACE) were compared among each group. Influencing factors for bleeding were investigated by multivariate Logistic regression analysis.ROC curves of GRACE score and TIMI risk score predicting bleeding and MACE was made, and AUC values were calculated.H-L test was conducted to compare the goodness of fit between GRACE score and TIMI risk score in the prediction of bleeding and MACE.Results The total coronary recanalization rates were 21.8% ( 19/87 ) , 51.7% ( 45/87 ) , 65.5% ( 57/87 ) and 77.0% ( 67/87 ) 30 min, 60 min, 90 min and 120 min after thrombolytic therapy.With the time extending from onset to thrombolytic therapy, there were no significant differences among the coronary recanalization rates of different time after thrombolytic therapy ( P >0.05 ) . The incidence of minor bleeding was 11.5% (10 cases) .There were 12 cases of post-infarction angina (13.8%), 8 cases of arrhythmia (9.2%) , 7 cases of recurrent myocardial infarction (8.0%) , 5 cases of heart failure (5.7%) and 3 cases of death (3.4%) .The incidence rates of bleeding and MACE of mid-risk groups and high-risk groups of GRACE score and TIMI risk score were higher than those of low -risk groups of GRACE score and TIMI risk score respectively, the incidence rates of bleeding and MACE of high-risk groups of GRACE score and TIMI risk score were higher than those of the mid-risk groups of GRACE score and TIMI risk score respectively ( P<0.05 ) .Multivariate Logistic regression analysis showed that female, age (≥70 years old) , WBC≥4 ×109/L, Hb<110 g/L, Scr≥133μmol/L and use of UFH+GPI were independent risk factors for in-hospital bleeding (P<0.05) .The AUC of predicting bleeding and MACE was 0.875 〔95%CI (0.776, 0.974)〕 for GRACE score and 0.867 〔95%CI (0.684, 0.934)〕 for TIMI risk score, which showed the two indicators both had predictive value for bleeding and MACE (the P values were 0.030 and <0.001 compared with AUC=0.5) .H-L test results showed that the goodness of fit of TIMI risk score (R2 =0.775) was not significantly different from that of GRACE score (R2 =0.698) (P>0.05) .Conclusion For STEMI patients who cannot take percutaneous coronary intervention ( PCI ) timely, thrombolytic therapy rhPro-UK can be applied for it brings high coronary recanalization rate and better safety and causes no increase in the incidence of bleeding and MACE, so thrombolytic therapy rhPro-UK is worth further application in clinical practice.Female STEMI patients with higher age have greater risk of bleeding and MACE, especially for patients complicated with increased WBC, anemia, renal insufficiency and using both UFH and GPI.关键词
心肌梗死/注射用重组人尿激酶原/疗效比较研究/溶栓/GRACE/心肌梗死溶栓试验危险评分Key words
Myocardial infarction/Recombinanthuman prourokinase for injection/Comparative effectiveness research/Thrombolysis/GRACE/TIMI risk score分类
医药卫生
