早期应用PCSK-9抑制剂对急性ST段抬高型心肌梗死罪犯血管自发再通患者的疗效分析

Efficiency analysis in early application of PCSK-9 inhibitor for treatment of acute ST segment elevation myocardial infarction patients with spontaneous recanalization of culprit vessels

  • 摘要:
      目的  观察早期应用PCSK-9抑制剂对急性ST段抬高型心肌梗死(STEMI)罪犯血管自发再通患者的临床疗效。
      方法  选取2020年1—6月郑州大学第二附属医院急诊行经皮冠状动脉介入术(PCI)后罪犯血管自发再通的STEMI患者124例,根据入院早期应用PCSK-9抑制剂情况分为依洛尤单抗组(n=70)和对照组(n=54)。比较2组手术成功率和心肌梗死溶栓试验(TIMI)血流分级,采用超声心动图及心功能标志物评价患者心脏功能恢复情况。记录2组患者随访6个月内主要不良心血管事件(MACE)发生率和临床不良反应事件发生率。
      结果  依洛尤单抗组患者的平均住院时间、低密度脂蛋白胆固醇、N端脑钠肽前体、术前及术后超敏C反应蛋白水平低于对照组,左室射血分数、术前及术后TIMI 3级血流比率高于对照组,差异均有统计学意义(P < 0.05)。依洛尤单抗组随访6个月内MACE发生率低于对照组,差异有统计学意义(P < 0.05)。
      结论  对于罪犯血管自发再通的STEMI患者,入院早期应用PCSK-9抑制剂能提高心肌再灌注量,改善心脏功能及预后。

     

    Abstract:
      Objective  To observe the clinical efficacy of early application of PCSK-9 inhibitors in treatment of acute ST segment elevation myocardial infarction (STEMI) patients with spontaneous recanalization of culprit vessels.
      Methods  A total of 124 STEMI patients with spontaneous recanalization of culprit vessels after percutaneous coronary intervention (PCI) from January to June 2020 in the Second Affiliated Hospital of Zhengzhou University were selected, they were divided into evolocumab group (n=70) and control group (n=54) according to the use of PCSK-9 inhibitor. The success rate of operation and blood flow classification of thrombolysis in myocardial infarction (TIMI) were compared between the two groups, and echocardiography and cardiac function markers were used to evaluate the recovery of cardiac function. Incidence rates of major adverse cardiovascular events (MACE) and clinical adverse events in 6 months of follow up were recorded.
      Results  The average hospital stay, low density lipoprotein cholesterol, N-terminal pro-brain natriuretic peptide, preoperative and postoperative high-sensitivity C reactive protein levels of the patients in the evolocumab group were significantly lower than those in the control group, while the left ventricular ejection fraction, preoperative and postoperative ratios of grade 3 blood flow of TIMI were significantly higher than those in the control group (P < 0.05). The incidence of MACE within 6 months of follow-up in the evolocumab group was significantly lower than that in the control group (P < 0.05).
      Conclusion  For STEMI patients with spontaneous recanalization of culprit vessels, early application of PCSK-9 inhibitor can increase myocardial reperfusion volume and improve cardiac function and prognosis.

     

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