冠状动脉解剖评分系统在急性ST段抬高型心肌梗死患者微血管阻塞中的预测价值  

The predictive value of coronary artery anatomical scoring systems for microvascular obstruction in patients with acute ST-segment elevation myocardial infarction

作　　者：李子文 王德华 张亚运 冯永丽 周艺[3] 周莹[1,2] LI Ziwen;WANG Dehua;ZHANG Yayun;FENG Yongli;ZHOU Yi;ZHOU Ying(Lianyungang Clinical Medical College,Nanjing Medical University,Lianyungang,Jiangsu Province 222003,China;Department of Imaging,the First Affiliated Hospital of Kangda College,Nanjing Medical University,Lianyungang,Jiangsu Province 222000,China;Department of Cardiology,Lianyungang First People’s Hospital,Lianyungang,Jiangsu Province 222000,China)

机构地区：[1]南京医科大学连云港临床医学院,江苏连云港222003 [2]南京医科大学康达学院第一附属医院影像科,江苏连云港222000 [3]连云港市第一人民医院心内科,江苏连云港222000

出　　处：《实用放射学杂志》2023年第5期745-749,共5页Journal of Practical Radiology

基　　金：中华国际医学交流基金会SKY影像科研基金项目(Z-2014-07-2101)。

摘　　要：目的探讨不同冠状动脉解剖评分系统对急性ST段抬高型心肌梗死(STEMI)患者首次经皮冠状动脉介入治疗(PCI)后发生微血管阻塞(MVO)的预测价值。方法回顾性分析首次接受PCI并行心脏磁共振(CMR)检查的急性STEMI患者,根据CMR结果将患者分为MVO组(21例)与非MVO组(34例),计算患者的SYNTAX积分、Gensini积分及其相应的罪犯血管积分,并测量CMR相关参数。结果55例急性STEMI患者,MVO组的SYNTAX积分、Gensini积分、罪犯SYNTAX积分、罪犯Gensini积分显著高于非MVO组(P<0.01)。受试者工作特征(ROC)曲线分析显示,罪犯Gensini积分在预测MVO中具有最大的曲线下面积(AUC)(AUC=0.877,P<0.001),在最佳阈值(44)的敏感度和特异度分别为0.905、0.765。在多变量logistic回归分析中,Gensini积分(比值比=1.123,P=0.044)与罪犯Gensini积分(比值比=1.132,P=0.038)被确定为MVO的独立预测因子。结论在首次接受PCI的急性STEMI患者中,Gensini积分与罪犯Gensini积分可能是MVO的预测指标。Objective To investigate the predictive value of different coronary artery anatomical scoring systems for microvascular obstruction(MVO)after first percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Patients with acute STEMI who first received PCI and cardiac magnetic resonance(CMR)examination were analyzed retrospectively.According to the CMR results,patients were divided into MVO group(21 patients)and non-MVO group(34 patients).The SYNTAX score,Gensini score and their corresponding culprit artery score were calculated,and CMR related parameters were measured.Results A total of 55 patients with acute STEMI,the SYNTAX score,Gensini score,culprit SYNTAX score,culprit Gensini score in MVO group were significantly higher than those in non-MVO group(P<0.01).Receiver operating characteristic(ROC)curve analysis showed that the culprit Gensini score had the maximum area under the curve(AUC)in predicting MVO(AUC=0.877,P<0.001),the optimal threshold of 44,the sensitivity and specificity were 0.905 and 0.765,respectively.In multivariate logistic regression analysis,Gensini score(odds ratio=1.123,P=0.044)and culprit Gensini score(odds ratio=1.132,P=0.038)were identified as independent predictors of MVO.Conclusion In patients with acute STEMI receiving PCI for the first time,the Gensini score and culprit Gensini score may be predictors of MVO.

关 键 词：心脏磁共振 急性ST段抬高型心肌梗死 微血管阻塞 积分 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]