急性ST段抬高型心肌梗死直接介入术后恢复期心肌铁沉积的危险因素分析  

Related factors of persistent iron in patients with acute ST-segment elevationmyocardial infarction after primary percutaneous coronary intervention

作　　者：郭倩 王晓[1] 郭芮丰 郭影影 严研[1] 公威 郑文[1] 艾辉[1] 阙斌[1] 聂绍平[1] GUO Qian;WANG Xiao;GUO Ruifeng;GUO Yingying;YAN Yan;GONG Wei;ZHENG Wen;AI Hui;QUE Bin;NIE Shaoping(Department of Center for Coronary Artery Disease,Division of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科、心血管内科冠心病中心

出　　处：《心肺血管病杂志》2023年第2期101-106,112,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家重点研发计划(2022YFC2505600,2020YFC2004800);北京市自然科学基金(7222046,7191002);北京市科技新星(Z201100006820087);北京市科技新星计划交叉学科合作课题(Z211100002121165)。

摘　　要：目的:探讨ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)后恢复期心肌铁沉积的危险因素。方法:前瞻性入选2019年10月至2021年9月,于北京安贞医院接受直接PCI且完成基线(术后3~7d)及恢复期(术后3~6个月)两次心脏磁共振(CMR)检查的STEMI患者。根据恢复期CMR图像是否存在铁沉积将患者分为两组,比较两组患者的临床特点并分析与恢复期铁沉积存在的相关危险因素。结果:共纳入148例患者,其中29例存在恢复期铁沉积。与恢复期不存在铁沉积的患者相比,恢复期存在铁沉积的患者中男性、高血压病史、前壁心肌梗死、术前TIMI血流0~1级的比例更高(P均<0.05)。多因素Logistic回归分析显示,既往高血压病史(OR=5.30,95%CI:1.64~17.09,P=0.005)、前壁梗死(OR=8.15,95%CI:1.76~37.62,P=0.007)、术前TIMI血流0~1级(OR=2.84,95%CI:1.08~7.48,P=0.034)是STEMI患者恢复期心肌存在持续铁沉积的危险因素。结论:高血压病史、前壁心肌梗死、术前TIMI血流0~1级是STEMI患者直接PCI术后恢复期心肌存在铁沉积的危险因素。Objective:The current study aimed to investigate the risk factors of persistent iron in patients post-ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods:The STEMI patients who underwent primary PCI in Beijing Anzhen Hospital from October 2019 to September 2021 and underwent serial cardiovascular magnetic resonance at index admission(3 to 7 days)and 3 to 6 months after primary PCI were prospectively enrolled.The T2-weighted CMR imaging detected persistent iron on follow-up CMR.The patients were divided into two groups according to the presence or absence of persistent iron in follow-up CMR images,and clinical characteristics of both groups were compared.Logistic regression models were used to analyze the risk factors associated with persistent iron.Resultss:A total of 148 patients were included,and 29 of them had persistent iron.Compared with patients without persistent iron,the patients with persistent iron were higher proportions of male,a history of hypertension,anterior infarct location,and TIMI blood flow grade 0-1 pre-PCI(all P<0.05).Multivariate logistic regression analysis showed that the occurrence of persistent iron was associated with the history of hypertension(adjusted OR=5.30,95%CI:1.64-17.09,P=0.005),anterior infarct location(adjusted OR=8.15,95%CI:1.76-37.62,P=0.007),and TIMI blood flow 0-1 pre-PCI(adjusted OR=2.84,95%CI:1.08-7.48,P=0.034).Conclusions:Presence of persistent iron was associated with a history of hypertension,anterior infarct location,and TIMI blood flow 0-1 pre-PCI in STEMI patients after PPCI.

关 键 词：心肌梗死 心肌铁沉积 经皮冠状动脉介入治疗 心脏磁共振 

分 类 号：R54[医药卫生—心血管疾病]