基于冠状动脉造影术中即刻新型评分系统对STEMI患者急诊PCI术中慢血流/无复流的预测价值和短期预后研究  

Prediction value and short-term prognosis of slow blood flow/no-reflow during emergency PCI in patients with acute ST-segment elevation myocardial infarction based on a novel immediate scoring system during coronary angiography

作　　者：吴红丽[1] 呼日乐巴特[1] 孙洪涛[1] 李志鹏 陈少青[1] Wu Hongli;Hu Rilebater;Sun Hongtao;Li Zhipeng;Chen Shaoqing(Department of Cardiology,The Affiliated Hospital of Inner Mongolia University for Nationalities,Tongliao 028000,China;不详)

机构地区：[1]内蒙古民族大学附属医院心血管内科,通辽028000

出　　处：《中国循证心血管医学杂志》2024年第4期457-461,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的基于临床指标和造影术中即刻影像学指标构建新型评分系统评估急性ST段抬高型心肌梗死(STEMI)接受急诊PCI(PPCI)术中慢血流/无复流的风险。方法本研究连续入选325例接受PPCI的STEMI患者作为建模组;另外连续入选412例患者作为验证组,用于验证该评分系统对慢血流/无复流(SF/NRF)的预测价值,并评估住院期间该评分系统高风险组与低风险组主要不良心血管事件的相关性。结果本研究使用5个变量建立SF/NRF预测模型。SF/NRF的独立预测因素为Killip≥2级、症状发作到球囊扩张时间≥4 h、初始TIMI血流0级、造影血栓负荷分级≥4和IRA管径≥3.5 mm。依据OR值对SF/NRF的独立预测因素进行赋分,进而建立SF/NRF的独立预测因素预测模型,使用受试者工作特征曲线(ROC)分析显示该模型评分≥7分对SF/NRF预测的敏感度为81.2%,特异度为72.3%(AUC=0.845,95%CI:0.788~0.902,P=0.012)。在验证队中使用该模型评分≥7分对SF/NRF预测的敏感度为78.2%,特异度为69.5%(AUC=0.752,95%CI:0.687~0.827,P=0.021)。在建模组、验证组和总人群中高危组(≥7分)住院期间主要不良心血管事件(MACE)显著高于对照组。结论基于冠状动脉造(冠脉)影术中即刻新型评分系统对STEMI患者PPCI术中SF/NRF具有良好的预测价值,且高风险组患者住院期间MACE显著高于低风险组。Objective To establish a new scoring system based on clinical and intraoperative imaging indicators to evaluate the risk of slow blood flow/no-reflow during primary PCI(PPCI)treatment for acute ST-segment elevation myocardial infarction(STEMI).Method 325 STEMI patients who underwent PPCI were selected as the derivation group in this study.In addition,412 consecutive patients were selected as the validation group to verify the predictive value of the scoring system for slow flow/no-reflow(SF/NRF).Furthermore,evaluate the correlation between major adverse cardiovascular events(MACE)in the high-risk and low-risk groups of the scoring system during hospitalization.Results This study used five variables to establish an SF/NRF prediction model.The independent predictive factors for SF/NRF were Killip≥2,time from symptom onset to balloon dilation≥4 hours,initial TIMI blood flow level 0,contrast thrombus burden grade≥4,and IRA diameter≥3.5 mm.Based on the OR value,the independent predictive factors of SF/NRF were scored,and an independent predictive factor prediction model for SF/NRF was established.Analysis using the receiver operating characteristic curve(ROC)showed that the sensitivity and specificity of the model for predicting SF/NRF were 81.2%and 72.3%,with a score of≥7(AUC=0.845,95%CI:0.788~0.902,P=0.012).The sensitivity and specificity of using this model to predict SF/NRF were 78.2%and 69.5%(AUC=0.752,95%CI:0.687~0.827,P=0.021)when scoring≥7 points in the validation team.The major adverse cardiovascular events(MACE)during hospitalization in the high-risk group(≥7 points)were significantly higher in the modeling group,validation group,and overall population than in the control group.Conclusion The novel scoring system based on immediate coronary angiography has good predictive value for SF/NRF during PPCI in STEMI patients,and the MACE during hospitalization in high-risk groups is significantly higher than that in low-risk groups.

关 键 词：急性ST段抬高型心肌梗死 急诊PCI 慢血流/无复流 预测因素 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]