冠状动脉微循环阻力评估急性ST段抬高型心肌梗死PCI患者预后的临床研究  

Clinical study of coronary microcirculation resistance in predicting the prognosis of PCI patients with acute ST-segment elevation myocardial infarction

作　　者：韩超 张弘 张慧 安雯 杨成昊 张凌霄 陈双宇 郜俊清[1] 刘宗军[1] HAN Chao;ZHANG Hong;ZHANG Hui;AN Wen;YANG Chenhao;ZHANG Lingxiao;CHEN shuangyu;GAO Junqing;LIU Zongjun(Putuo District Central Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai,200062,China)

机构地区：[1]上海中医药大学附属普陀医院,上海200062

出　　处：《临床心血管病杂志》2024年第4期317-323,共7页Journal of Clinical Cardiology

基　　金：上海市“科技创新行动计划”医学创新研究专项(No:20Y11910100、21Y11909600、22Y11909600);上海市普陀区卫生健康系统科技创新项目计划(No:ptkwws202320);上海市普陀区卫生系统临床优势学科(No:2023ysxk01);普陀区中心医院百人计划(No:2022-RCIC-01);上海市第六人民医院医疗集团科学研究课题(No:21-ly-01);成都中医药大学“杏林学者”学科人才科研提升计划(No:YYZX2022168)。

摘　　要：目的:探讨冠状动脉(冠脉)微循环阻力评估急性ST段抬高型心肌梗死(STEMI)患者预后的价值。方法:本研究是一项前瞻性、观察性、单中心研究,纳入140例成功接受急诊经皮冠脉介入(PCI)治疗的STEMI患者,使用造影微循环阻力指数(CaIMR)分析罪犯血管和非罪犯血管的微循环阻力,其中诊断冠脉微血管功能障碍(CMD)61例(CMD组),诊断非CMD 79例(非CMD组)。随访12个月,观察患者主要不良心血管事件(MACE,包括全因死亡、再次心肌梗死、因心衰住院及再次血运重建的复合结局)发生情况。采用Cox回归分析PCI术后1年MACE发生的预测因子。结果:CMD组MACE发生率显著高于非CMD组(10.13%vs 24.60%,P<0.05)。多因素Cox回归分析显示,术后CaIMR(HR=5.887,95%CI:1.966~17.631,P<0.002)、呋塞米使用(HR=4.38,95%CI:1.595~12.026,P=0.004)、肌钙蛋白(第7天)(HR=1.011,95%CI:1.003~1.018,P=0.004)以及Killip分级(HR=1.878,95%CI:1.28~2.756,P=0.001)是STEMI患者PCI术后1年内MACE发生的独立预测因子。罪犯血管CMD与心血管性死亡、心衰发作以及主要不良事件发生率相关,非罪犯血管与各主要不良事件发生率无显著相关性。结论:STEMI患者PCI术后的CaIMR对临床预后具有很好的预测作用。Objective To explore the value of coronary microcirculation resistance in evaluating the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The study was a prospective,observational,single-center study involving 140 STEMI patients who successfully received emergency percutaneous coronary intervention(PCI)treatment.The contrast microcirculatory resistance index(CaIMR)was used to analyze the microcirculation resistance of culprit and non-culprit vessels,with 61 cases diagnosed with coronary microvascular dysfunction(CMD group)and 79 cases diagnosed with non-CMD(non-CMD group).Patients were followed up for 12 months to observe the occurrence of major adverse cardiovascular events(MACE,including all-cause mortality,myocardial infarction recurrence,hospitalization due to heart failure,and revascularization).The Cox regression model was used to analyze the predictors for MACE one year after PCI.Results The incidence of MACE was significantly higher in the CMD group than in the non-CMD group(10.13%vs 24.60%,P<0.05).Multivariate Cox regression analysis showed that postoperative CaIMR(HR=5.887,95%CI:1.966-17.631,P<0.002),furosemide usage(HR=4.38,95%CI:1.595-12.026,P=0.004),troponin(on the 7th day)(HR=1.011,95%CI:1.003-1.018,P=0.004),and Killip grade(HR=1.878,95%CI:1.28-2.756,P=0.001)were independent predictors of MACE occurrence in one year after PCI in STEMI patients.Criminal vascular disease CMD was associated with cardiovascular death,heart failure attacks,and the incidence of major adverse events,while non-criminal blood vessels CMD was not significantly correlated with the incidence of major adverse events.Conclusion CaIMR after PCI has a good predictive effect on the clinical prognosis in patients with acute STEMI.

关 键 词：冠脉微循环阻力指数 主要心血管不良事件 冠状动脉微循环功能障碍 急性ST段抬高型心肌梗死 

分 类 号：R541.4[医药卫生—心血管疾病]