双核素心肌显像评估的心肌活性对急性心肌梗死患者预后的预测价值  

Predictive value of myocardial activity evaluated by dual nuclide myocardial imaging to prognosis in patients with acute myocardial infarction

作　　者：李肖红[1] 秦永德[1] 张奇洲[1] 卜国森 王娇 刘志强[2] Li Xiaohong;Qin Yongde;Zhang Qizhou;Bu Guosen;Wang Jiao;Liu Zhiqiang(Department of Nuclear Medicine,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;不详)

机构地区：[1]新疆医科大学第一附属医院核医学,乌鲁木齐830011 [2]新疆医科大学第一附属医院综合心脏内科,乌鲁木齐830011

出　　处：《中国循证心血管医学杂志》2024年第4期462-465,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨双核素心肌显像对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后远期主要不良心血管事件(MACE)的预测价值。方法自2015年1月至2020年12月,回顾性收集新疆医科大学第一附属医院就诊的AMI患者95例,随访3年,根据患者术后是否发生MACE事件分为MACE组(n=42)和对照组(n=53),比较两组患者临床特征和双核素心肌显像相关参数差异,分析双核素心肌显像相关参数对MACE事件的预测价值。结果与对照组比较,MACE组患者糖尿病发生率显著增高(42.86%vs.22.64%,P=0.035);冠状动脉(冠脉)狭窄程度显著增高[(73.67±11.57)%vs.(66.11±8.69)%,P<0.001];左心室射血分数(LVEF)显著降低(47.45±3.83 vs.52.13±4.31,P<0.001);心肌缺血总积分显著增高[(14.29±4.20)%vs.(9.89±3.33)%,P<0.001];心肌灌注/代谢不匹配百分比显著增高(16.58±1.61 vs.15.69±2.14,P=0.028)。LVEF对急性心肌梗死患者PCI术后MACE事件具有一定预测价值,曲线下面积(AUC)为0.777(95%CI:0.686~0.868,P<0.001)。冠脉狭窄程度、心肌缺血总积分对预测AMI患者PCI术后MACE事件具有一定预测价值,AUC分别为0.676、0.784。多因素Logistics回归分析显示LVEF<50%、心肌缺血总积分>12是AMI患者PCI术后3年内发生MACE事件的独立危险因素(P<0.05)。结论双核素心肌显像相关参数可作为AMI患者PCI术后MACE事件的预测指标之一。Objective To investigate the predictive value of dual nuclide myocardial imaging to long-term major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods AMI patients(n=95)were retrospectively chosen from the First Affiliated Hospital of Xinjiang Medical University from Jan.2015 to Dec.2020,and they were followed up for 3 y.All patients were divided,according to MACE occurrence after PCI,into MACE group(n=42)and control group(n=53).The differences in clinical characteristics and parameters related to dual nuclide myocardial imaging were compared between 2 groups.The predictive value of parameters related to dual nuclide myocardial imaging to MACE was analyzed.Results The incidence of diabetes increased significantly(42.86%vs.22.64%,P=0.035),severity of coronary stenosis increased significantly[(73.67±11.57)%vs.(66.11±8.69)%,P<0.001],left ventricular ejection fraction(LVEF)decreased significantly(47.45±3.83 vs.52.13±4.31,P<0.001),the total score of myocardial ischemia increased significantly[(14.29±4.20)%vs.(9.89±3.33)%,P<0.001],and mismatch percentage of myocardial perfusion/metabolism increased significantly(16.58±1.61 vs.15.69±2.14,P=0.028)in MACE group compared with control group.LVEF had some predictive value to MACE after PCI(AUC=0.777,95%CI:0.686~0.868,P<0.001).The severity of coronary stenosis and the total score of myocardial ischemia had some predictive value to MACE after PCI(AUC=0.676,AUC=0.784).The results of multi-factor Logistics regression analysis showed that LVEF<50%and the total score of myocardial ischemia>12 were independent risk factors of MACE within 3 y after PCI in AMI patients(P<0.05).Conclusion The parameters related to dual nuclide myocardial imaging can be taken as one of predictive indicators for MACE in AMI patients after PCI.

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 核素心肌显像 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]