沙库巴曲缬沙坦联合达格列净对STEMI患者急诊PCI术后心功能及预后的影响

摘要/Abstract

摘要： 目的探究沙库巴曲缬沙坦（ARNI）和达格列净（SGLT2i）对急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）术后患者心功能及预后的影响。方法选取2019年1月—2020年12月烟台市莱阳中心医院收治的140例STEMI并成功行急诊PCI术患者,满足LVEF≥40%、NT-poBNP≥600 ng/L,根据随机数表法分为缬沙坦组（ARB组）、ARNI组及联合治疗组,用超声心动图参数和氨基末端脑钠肽前体（NT-proBNP）的变化来评估对心功能的影响。结果三组患者临床基线资料以及相关信息比较,差异无统计学意义（P>0.05）。联合治疗组NT-proBNP下降程度较ARB组更明显（P<0.05）,联合治疗组左室射血分数（LVEF）、左室短轴缩短率（FS）提高及左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）缩小程度较ARB组更明显（P<0.05）。随访中共有23例发生主要心脏不良事件（MACE）,三组MACE发生率比较,差异无统计学意义（P>0.05）。多因素Cox回归分析结果显示,病变程度、术中应用替罗非班和多巴胺是MACE发生的独立危险因素（P<0.05）。结论沙库巴曲缬沙坦联合达格列净可以有效降低NT-proBNP水平,进一步提高患者的LVEF,缩小LVEDD,改善患者的心脏结构及功能。病变复杂、术中应用替罗非班和多巴胺提示预后不良。

关键词: 沙库巴曲缬沙坦, 达格列净, 急性心肌梗死, 经皮冠状动脉介入治疗, 预后

Abstract: Objective To investigate the effect of sacubitril/valsartan (ARNI) combined with dapagliflozin(SGLT2i) on cardiac function and prognosis after emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 140 eligible patients with STEMI who received emergency PCI were enrolled in the study and randomly assigned to receive treatment from January 2019 to December 2020. The patients presenting with left ventricular ejection fraction (LVEF)≥40% and NT-proBNP≥600 ng/L who were continuously enrolled. The patients were randomly divided into combination therapy group, ARNI group and ARB group. The data changes of NT proBNP, left ventricle ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and left ventricular fractional shortening (FS) before and after administration were taken as the primary endpoint. Follow up to June 2021, the occurrence of major adverse cardiovascular events (MACE) will be the secondary end point of this trial. Results There was no significant difference in clinical treatment data between the three groups. Compared with the ARB group, the decrease of NT-proBNP in the combination treatment group was more obvious, and the increase in LVEF and the reduction of LVEDD, LVESD were more obvious(P<0.05). A total of 23 patients developed MACE during follow-up, and there was no significant difference in the incidence of MACE between the three groups (P>0.05). Multivariate Cox regression analysis showed that the degree of lesion, intraoperative use of tirofiban and dopamine were independent risk factors for MACE (P<0.05). Conclusion Sacubitril/valsartan combined with dapagliflozin can more effectively reduce NT-proBNP levels, which may further increase the LVEF and reduce LVEDD, and improve the structure and function of the heart. Lesion complexity, intraoperative use of tirofiban, and dopamine are suggestive of a poor prognosis.

Key words: sacubitril/valsartan, dapagliflozin, acute myocardial infarction, percutaneous coronary intervention, prognosis

中图分类号:

G542.22

吕国令, 张艺铭, 黄建英, 许耀. 沙库巴曲缬沙坦联合达格列净对STEMI患者急诊PCI术后心功能及预后的影响[J]. 中华养生保健, 2024, 42(13): 53-58.

LYU Guo-ling, ZHANG Yi-ming, HUANG Jian-ying, XU Yao. Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Cardiac Function and Prognosis after Emergency PCI in Patients with Acute ST-Segment Elevation Myocardial Infarction[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(13): 53-58.

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