基于核素心肌灌注显像评估冠心病PCI术后早期残留心肌缺血及其影响因素  

Evaluation and influencing factors of early residual myocardial ischemia on myocardial perfusion imaging after percutaneous coronary intervention for coronary artery disease

作　　者：杨志敏 杨晓宇[2] 王跃涛[1] 俞雯吉 李柯 邱春 张飞飞 邵晓梁[1] 孟宝升 王建锋[1] Yang Zhimin;Yang Xiaoyu;Wang Yuetao;Yu Wenji;Li Ke;Qiu Chun;Zhang Feifei;Shao Xiao-liang;Meng Baosheng;Wang Jianfeng(Department of Nuclear Medicine,the Third Affiliated Hospital of Soochow University,the First People′s Hospital of Changzhou,Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging,Soochow University,Changzhou 213003,China;Department of Cardiology,the Third Affiliated Hospital of Soochow University,the First People′s Hospital of Changzhou,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院、常州市第一人民医院核医学科、苏州大学核医学与分子影像临床转化研究所,常州213003 [2]苏州大学附属第三医院、常州市第一人民医院心血管内科,常州213003

出　　处：《中华核医学与分子影像杂志》2024年第9期539-544,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(82272031,81871381);江苏省重点研发计划(社会发展)项目(BE2021638);常州市"十四五"卫生健康高层次人才培养工程-拔尖人才((2022)260);常州市临床医学中心(核医学)(CZZX202204)。

摘　　要：目的应用核素心肌灌注显像(MPI)评价冠状动脉(简称冠脉)粥样硬化性心脏病(简称冠心病)患者经皮冠脉介入治疗术(PCI)术后早期残留心肌缺血,并探讨术后早期残留心肌缺血的影响因素。方法前瞻性连续纳入2020年1月至2022年12月于常州市第一人民医院行完全血运重建的冠心病患者127例[男107例、女20例,年龄(60.3±9.6)岁],患者于PCI术后1~3个月内行静息+负荷MPI。将MPI提示罪犯血管供血区仍存在心肌可逆性灌注稀疏/缺损定义为早期残留心肌缺血,据此将行PCI的罪犯血管分为残留缺血和无缺血,比较2组严重狭窄(≥90%)的罪犯血管、分叉病变、冠脉弥漫性病变等心血管检查资料的差异(χ^(2)检验),采用logistic回归分析罪犯血管PCI术后早期残留心肌缺血的影响因素。结果127例患者的148支罪犯血管中,残留缺血罪犯血管49支(33.1%,49/148)。残留缺血组PCI术前严重狭窄的罪犯血管比例高于无缺血组[69.4%(34/49)与49.5%(49/99);χ^(2)=5.27,P=0.022],残留缺血组病变处为分叉病变的比例高于无缺血组[28.6%(14/49)与10.1%(10/99);χ^(2)=8.23,P=0.004],其冠脉弥漫性病变占比略高于无缺血组[14.3%(7/49)与4.0%(4/99);χ^(2)=3.62,P=0.057]。多因素logistic回归分析示,分叉病变[比值比(OR)=4.087,95%CI:1.615~10.344,P=0.003]、冠脉弥漫性病变(OR=4.208,95%CI:1.115~15.878,P=0.034)是罪犯血管PCI术后早期残留心肌缺血的独立影响因素。结论冠脉罪犯血管PCI完全血运重建术后仍有近1/3的血管存在早期残留心肌缺血;分叉病变、冠脉弥漫性病变是罪犯血管早期残留心肌缺血的独立影响因素。ObjectiveTo evaluate early residual myocardial ischemia after successful percutaneous coronary intervention(PCI)in patients with coronary artery disease by using myocardial perfusion imaging(MPI)and investigate independent influencing factors of early residual myocardial ischemia.MethodsFrom January 2020 to December 2022,127 patients(107 males,20 females;age(60.3±9.6)years)with coronary artery disease who underwent PCI complete revascularization at the First People′s Hospital of Changzhou were consecutively enrolled prospectively.All patients underwent rest and stress MPI within 1-3 months after PCI.Reversible myocardial perfusion defect in the blood supply area of the culprit vessels in stress and rest MPI was defined as early residual myocardial ischemia after PCI.Accordingly,the culprit vessels undergoing PCI were divided into residual ischemic group and non-ischemic group.Differences of cardiovascular examination between two groups were compared(χ^(2) test),such as proportion of culprit vessels with severe stenosis(≥90%),proportion of bifurcation lesions,and proportion of diffuse coronary disease.Logistic regression analyses were performed to identify influencing factors for early residual myocardial ischemia.ResultsAmong 148 culprit vessels undergoing PCI in 127 patients,early residual myocardial ischemia was present in 49 vessels(33.1%,49/148).The proportion of culprit vessels with severe stenosis before PCI in residual ischemia group was higher than that in non-ischemia group(69.4%(34/49)and 49.5%(49/99);χ^(2)=5.27,P=0.022).The proportion of bifurcation lesions in residual ischemic group was also higher than that in non-ischemic group(28.6%(14/49)and 10.1%(10/99);χ^(2)=8.23,P=0.004),with a slightly higher proportion of diffuse coronary disease compared to non-ischemic group(14.3%(7/49)and 4.0%(4/99);χ^(2)=3.62,P=0.057).Multivariate logistic regression analysis showed that bifurcation lesion(odds ratio(OR)=4.087,95%CI:1.615-10.344,P=0.003)and diffuse coronary disease(OR=4.208,95%CI:1.115-15.878,P=0

关 键 词：冠心病 经皮冠状动脉介入治疗 心肌缺血 心肌灌注显像 99M锝甲氧基异丁基异腈 

分 类 号：R541.4[医药卫生—心血管疾病]