目的 探讨单支冠脉病变心肌梗死的冠脉病变特点及相关危险因素。方法 回顾性纳入2021年12月至2023年10月就诊于湘西土家族苗族自治州人民医院的571例急性ST段抬高型心肌梗死(STEMI)患者,根据冠脉病变情况分为单支冠脉病变组(n=174),多支冠脉病变组(n=397)。比较两组患者临床资料,采用多因素Logistic回归分析单支冠脉病变STEMI的影响因素。结果 单支冠脉病变STEMI患者的常见罪犯血管为前降支[118例(67.8%)]
170例(97.7%)病变位于主支,以冠脉近段受累最常见[96例(55.2%)]。与多支冠脉病变组比较,单支冠脉病变组男性比率较高,年龄、尿酸、高血压、糖尿病比率较低(P<0.05或<0.01)。多因素Logistic回归分析结果显示,男性(OR=12.049
95%CI:2.412~23.667)、高密度脂蛋白胆固醇(HDL-C)(OR=16.317
95%CI:1.987~134.010)与单支冠脉病变STEMI正相关。单因素Logistic回归分析显示危险因素数目与之发生负相关,OR为0.754
95%CI:0.622~0.914。结论 STEMI患者中,男性、HDL-C是单支冠脉病变STEMI的危险因素,且危险因素数目与之发生负相关;其罪犯血管最常见于左前降支,多表现为冠脉主支、近段受累。
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