急性ST段抬高型心肌梗死患者PCI术后心肌微循环特征与冠状动脉高血栓负荷的相关性  

Correlation between myocardial microcirculation characteristics and coronary artery high thrombotic load in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

作　　者：石健佑 何艳 Shi Jianyou;He Yan(Department of Cardiovascular Medicine,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China;不详)

机构地区：[1]贵州医科大学附属医院心血管内科,贵阳550004

出　　处：《中国循证心血管医学杂志》2024年第11期1374-1378,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术后心肌微循环特征与冠状动脉高血栓负荷的相关性。方法选择2020年1月至2022年1月于贵州医科大学附属医院接受PCI的183例STEMI患者作为研究对象,根据血栓负荷状态分为高血栓负荷组(n=60)与低血栓负荷组(n=123)。比较两组患者的一般资料,以及PCI术前术后心肌微循环特征指标。采用析因设计方差分析比较PCI术后冠状动脉血流储备(CFR)与微循环阻力指数(IMR)的交互作用对冠状动脉血栓负荷影响。采用受试者工作特征(ROC)评估CFR和IMR对STEMI患者发生冠状动脉高血栓负荷的预测价值。另根据SYNTAX积分将STEMI患者分为高积分亚组(≥33分,n=75)和低积分亚组(<33分,n=108),比较不同严重程度的高血栓负荷患者临床资料。通过Logistic回归分析并构建校正模型,分析不同微循环特征指标与高积分亚组患者冠状动脉高血栓负荷的关系。采用Cox比例风险回归模型,分析CFR和IMR水平及SYNTAX积分对冠状动脉高血栓负荷的影响。结果析因设计资料的方差分析结果显示,CFR与IMR在冠状动脉血栓负荷方面存在交互作用。CFR和IMR对STEMI患者发生冠状动脉高血栓负荷的预测效能良好,且二者联合预测冠状动脉高血栓负荷,预测效能更高。通过Logistic回归分析可知,校正混杂因素后,CFR、IMR与高积分亚组患者冠状动脉高血栓负荷的OR值分别为0.806、1.980,得出CFR、IMR是高积分亚组患者冠状动脉高血栓负荷的独立危险因素(P<0.05)。交互作用分析发现,CFR、IMR与SYNTAX积分存在相乘交互作用。结论STEMI患者PCI术后CFR与IMR是冠状动脉高血栓负荷的影响因素,且对冠状动脉高血栓负荷的影响均存在相加及相乘交互作用。Objective To investigate the correlation between myocardial microcirculation characteristics and coronary artery high thrombotic load in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods STEMI patients undergone PCI(n=183)were chosen from Affiliated Hospital of Guizhou Medical University from Jan.2020 to Jan.2022,and divided,according to thrombotic load status,into high-thrombotic load group(n=60)and low-thrombotic load group(n=123).The general materials and indexes of myocardial microcirculation characteristics were compared between 2 groups before and after PCI.The influence of interaction of coronary flow reserve(CFR)and index of microcirculatory resistance(IMR)on coronary artery thrombotic load was analyzed by using factorial design analysis of variance.The predictive value of CFR and IMR to coronary artery high thrombotic load was reviewed by using ROC curve analysis in STEMI patients.STEMI patients were divided,according to SYNTAX scores,into high-score subgroup(scores≥33,n=75)and low-score subgroup(scores<33,n=108),and clinical materials were compared between 2 subgroups.A correction model was established by using Logistic regression analysis.The relationship between indexes of myocardial microcirculation characteristics and coronary artery high thrombotic load in high-score subgroup was analyzed.The influence of CFR,IMR and SYNTAX scores on coronary artery high thrombotic load was analyzed by using Cox proportional hazard regression model.Results The results of factorial design analysis of variance showed that there was interaction between CFR and IMR,and predictive efficacy of CFR and IMR to coronary artery high thrombotic load was high in STEMI patients,and predictive efficacy of CFR combined with IMR was higher.The results of Logistic regression analysis showed that,after correcting confounding factors,CFR and IMR were independent risk factors of coronary artery high thrombotic load(OR=0.806,OR=1.980)in high-score subgroup(P<0.0

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 微循环 血栓 

分 类 号：R542.22[医药卫生—心血管疾病]