急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后发生微循环堵塞的关联因素研究  

Factors associated with microvascular obstruction in patients with acute ST-segment elevation myocardial infarction after PCI

作　　者：王仁学 毛琳霜 姜子超 刘康 张颖[2] 凌维维 吴丹[2] 钱赓[2] WANG Renxue;MAO Linshuang;JIANG Zichao;LIU Kang;ZHANG Ying;LING Weiwei;WU Dan;QIAN Geng(Department of Cardiology,Jiangnan Hospital,Changzhou 213000,Jiangsu Province,China;Department of Cardiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]常州江南医院心内科,江苏常州213000 [2]解放军总医院第六医学中心心内科,北京100853

出　　处：《解放军医学院学报》2021年第12期1254-1258,共5页Academic Journal of Chinese PLA Medical School

基　　金：中国心血管健康联盟冠脉微血管疾病创新基金(2018-CCA-CMVD-04)。

摘　　要：背景微循环堵塞(microvascular obstruction,MVO)增加急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后发生不良事件的风险。目的探讨急性STEMI患者行PCI术后冠状动脉发生微循环堵塞的独立关联因素。方法采用回顾性研究方法,收集2018年1月-2020年12月于常州江南医院心内科及解放军总医院第六医学中心心内科行急诊PCI的125例STEMI患者的临床资料,其中男性109例,女性16例,平均年龄(56.91±10.85)岁。根据术后是否发生微循环阻塞分为MVO组(n=54例)与非MVO组(n=71例)。采用多因素logistic回归分析STEMI患者PCI术后发生MVO的独立危险因素。结果多因素logistic回归分析显示,术前白细胞水平(OR:1.157,95%CI:1.008~1.328,P=0.039),支架置入数量(OR:1.916,95%CI:1.069~3.436,P=0.029),心肌梗死范围>20%(OR:6.302,95%CI:2.386~16.644,P<0.001)是急性STEMI患者行急诊PCI术后发生MVO的独立危险因素。结论术前白细胞水平、支架置入数量和心肌梗死范围>20%是急性STEMI患者行急诊PCI术后发生MVO的预测因子,早期进行这些危险因素的监测可以初步评估PCI术后MVO的发生风险。Background Microvascular obstruction(MVO)increases the risk of adverse events in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Objective To investigate the factors associated with coronary MVO in patients with ST-segment elevation infraction after PCI.Methods A retrospective analysis was conducted in 125 patients with acute ST-segment elevation infraction who underwent primary percutaneous coronary intervention(PPCI)in the department of cardiology medicine,Jiangnan Hospital,and the department of cardiology medicine,the First Medical Center of Chinese PLA General Hospital.There were 109 males and 16 females,with an average age of(56.91±10.85)years old.According to the occurrence of MVO during postoperative periods,the patients were divided into MVO group(n=54)and non-MVO group(n=71).Logistic regression was used to analyze the factors associated with microvascular obstruction in STEMI patients after PCI.Results Multivariate logistic regression showed that preoperative level of white blood cell(OR:1.157,95%CI:1.008-1.328,P=0.039),the number of stents implanted(OR:1.916,95%CI:1.069-3.436,P=0.029)and myocardial infarct size>20%(OR:6.302,95%CI:2.386-16.644,P<0.001)were independently associated with the occurrence of MVO in acute STEMI patients after PCI.Conclusion Preoperative level of white blood cell,the number of stents implanted and myocardial infarct size>20%can predict the occurrence of MVO in STEMI patients after PCI.Monitoring these factors in the early stage can initially assess the risk of developing MVO in STEMI patients who underwent PCI.

关 键 词：心肌梗死 冠状动脉介入治疗 微循环堵塞 心脏核磁 支架置入 

分 类 号：R542.22[医药卫生—心血管疾病]