左西孟旦联合强化抗血小板治疗对急性ST段抬高型心肌梗死并心力衰竭患者心功能改善及预后的影响研究

Effect of levosimendan combined with intensified antiplatelet therapy on cardiac function improvement and prognosis in patients with acute ST-elevation myocardial infarction complicated by heart failure

摘要:

目的 探讨左西孟旦联合强化抗血小板治疗对急性ST段抬高型心肌梗死（STEMI）并心力衰竭患者心功能改善及预后的影响。方法 回顾性分析2022年6月—2024年6月乐山市人民医院纳入的102例STEMI伴有心力衰竭患者的临床资料，根据不同的治疗方案分为对照组和研究组，各51例。两组均接受常规治疗，对照组在常规治疗基础上接受多巴酚丁胺，研究组在常规治疗基础上接受左西孟旦。对比两组心功能、心室肌稳定性［校正QT离散度（QTcd）、T波峰末间期（Tpe）］、血小板指标、基质金属蛋白酶-9（MMP-9）、生长分化因子-15（GDF-15）、髓过氧化物（MPO）、血清N末端脑钠肽前体（NT-proBNP）、预后状况［心血管不良事件（MACE）发生率、再住院率、病死率］差异。结果 研究组治疗前后左室射血分数、左室舒张末期内径、左室短轴缩短率的差值均高于对照组（P <0.05）。研究组治疗前后QTcd、Tpe的差值均低于对照组（P <0.05）。研究组治疗前后血小板活化因子、血小板计数的差值均高于对照组（P <0.05）。研究组治疗前后MMP-9、GDF-15、MPO、NT-proBNP的差值均高于对照组（P <0.05）。两组1、3、6个月MACE发生率、病死率比较，差异均无统计学意义（P >0.05）。研究组再住院率低于对照组（P <0.05）。结论 左西孟旦联合强化抗血小板治疗能够显著改善STEMI并心力衰竭患者的心功能、心室肌稳定性、心肌损伤水平，并有效降低再住院率，显示出优异的治疗效果和良好的预后。

Abstract:

Objective To evaluate the effects of levosimendan combined with intensified antiplatelet therapy on cardiac function improvement and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) accompanied by heart failure.Methods A retrospective analysis was conducted on the clinical data of 102 patients with STEMI and heart failure treated at Leshan People's Hospital from June 2022 to June 2024. Patients were divided into a control group and a study group, each comprising 51 patients. Both groups received standard treatments. The control group received additional dobutamine on top of standard treatment, whereas the study group was treated with levosimendan. The two groups were compared in terms of cardiac function, ventricular myocardial stability [corrected QT dispersion (QTcd) and T-peak to T-end interval (Tpe)], platelet indicators, matrix metalloproteinase-9 (MMP-9), growth differentiation factor-15 (GDF-15), myeloperoxidase (MPO), serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), and prognostic outcomes [incidence of major adverse cardiovascular events (MACE), rehospitalization rate, and mortality].Results The differences in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular fractional shortening (LVFS) before and after treatment in the study group were higher than those in the control group (P < 0.05). The differences in QTcd and Tpe before and after treatment were significantly lower in the study group than in the control group (P < 0.05). The differences in the platelet-activating factor level and the platelet count before and after treatment were significantly higher in the study group than in the control group (P < 0.05). Moreover, the differences in levels of MMP-9, GDF-15, MPO, and NT-proBNP before and after treatment were also significantly higher in the study group than in the control group (P < 0.05). There were no statistically significant differences between the two groups in the incidence of MACE or mortality at 1, 3, and 6 months (P >0.05). The study group showed a lower rehospitalization rate compared to the control group (P < 0.05).Conclusion Levosimendan combined with intensified antiplatelet therapy significantly improves cardiac function, ventricular myocardial stability, and the level of myocardial injury in patients with acute ST-elevation myocardial infarction complicated by heart failure. It also effectively reduces the rehospitalization rate, demonstrating excellent therapeutic effects and favorable prognosis.