PCI治疗STEMI患者高岭土诱导的最大振幅与血管造影慢血流/无复流现象和ST段回落受损的关系  

Relationship between Kaolin⁃induced Maximum Amplitude in PCI Treatment of STEMI Patients and Slow/No⁃reflow Phenomenon in Angiography and Impaired ST⁃segment Regression

作　　者：师杭飞 薛凯 席小立 卞明涛 SHI Hangfei;XUE Kai;XI Xiaoli;BIAN Mingtao(Department of Cardiology,The Second Affiliated Hospital of the Air Force Military Medical University,Xi′an 710038,Shaanxi,China)

机构地区：[1]空军军医大学第二附属医院心内科,陕西西安710038

出　　处：《中国分子心脏病学杂志》2024年第6期6471-6477,共7页Molecular Cardiology of China

基　　金：陕西省重点研发计划-一般项目-社会发展领域(2018SF-056)

摘　　要：目的探讨高岭土诱导的最大振幅(MA_(凝血酶))与具有高血栓负荷的ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后慢血流/无复流(CSF/NRF)和ST段回落(STR)受损之间的关系。方法对2019年4月至2023年3月在空军军医大学第二附属医院接受急诊PCI的连续STEMI患者进行回顾性研究,共225例患者被纳入分析。所有患者均符合标准诊断标准,并在症状出现后12 h内接受急诊PCI。在PCI术前使用血栓弹性成像法测量MA_(凝血酶)水平。PCI后血管造影术将CSF/NRF定义为心肌梗死溶栓(TIMI)0~2级,通过心电图将STR受损定义为STR<50%。结果根据术后最终TIMI血流分级分为两组:42例(18.67%)患者血管造影术发现CSF/NRF现象。与正常复流组相比,CSF/NRF组MA_(凝血酶)水平更高[61.50(54.0,70.0)mm比52.0(50.0,55.0)mm,P<0.001]。根据MA_(凝血酶)水平中位值分层,CSF/NRF现象的发生率随着MA_(凝血酶)的增加而增加,尤其是MA_(凝血酶)>56.0 mm亚层患者CSF/NRF发生率较其他组患者显著增加(P<0.001)。经受试者工作特征(ROC)曲线和限制性立方样条(RCS)进行建模,当MA_(凝血酶)>56.0 mm时显示出良好的预测CSF/NRF风险的能力[曲线下面积(AUC)=0.782,P<0.001],且MA_(凝血酶)水平与CSF/NRF之间存在非线性关系。多元logistic回归模型分析也表明,MA_(凝血酶)水平是CSF/NRF的独立危险因素(P<0.001)。在正常复流组的183例患者中,77例(42.08%)患者的STR较低(即STR<50%)。经ROC曲线分析,MA_(凝血酶)水平也能够良好地预测STR受损(AUC=0.674)。结论在接受PCI治疗的STEMI患者中,高MA_(凝血酶)水平(≥56.0 mm)与CSF/NRF风险增加和STR受损显著相关。Objective To investigate the relationship between kaolin induced maximum amplitude(MAthrombin)and impaired slow flow/no reflow(CSF/NRF)and ST⁃segment regression(STR)after primary percutaneous coronary intervention(pPCI)in patients with ST elevation myocardial infarction(STEMI)with high thrombotic load.Methods A retrospective study was conducted on consecutive STEMI patients who received pPCI in the Second Affiliated Hospital of the Air Force Military Medical University from April 2019 to March 2023.A total of 225 patients were included in the analysis.All patients met the standard diagnostic criteria and underwent emergency pPCI within 12 hours of symptom onset.MAthrombin levels were measured by thrombus elastography before PCI.Post⁃PCI angiography defined CSF/NRF as myocardial infarction thrombolysis(TIMI)grade 0⁃2 and impaired STR by ECG as STR<50%.Results The patients were divided into two groups according to the final TIMI blood flow grading:42 patients(18.67%)found CSF/NRF phenomenon by angiography.MAthrombin levels were higher in the CSF/NRF group than in the normal reflow group[61.50(54.0,70.0)mm vs.52.0(50.0,55.0)mm,P<0.001].Stratified according to median MAthrombin levels,the incidence of CSF/NRF phenomenon increased with the increase of MAthrombin,especially the incidence of CSF/NRF was significantly higher in patients with MAthrombin>56.0 mm sublayer than in other groups(P<0.001).Modeling by subject operating characteristic curves and restricted cubic splines(RCS)showed a good ability to predict CSF/NRF risk when MAthrombin>56.0 mm(AUC=0.782,P<0.001),and a non⁃linear relationship between MAthrombin levels and CSF/NRF.Multivariate Logistic regression analysis also showed that MAthrombin level was an independent risk factor for CSF/NRF(P<0.001).Of 183 patients in the normal flow group,77(42.08%)had low STR(STR<50%).ROC curve analysis showed that MAthrombin level was also a good predictor of STR damage(AUC=0.674).Conclusion In STEMI patients treated with pPCI,high MAthrombin levels(≥56.0 mm)were

关 键 词：高岭土诱导的最大振幅 ST段抬高型心肌梗死 慢血流/无复流 ST段回落受损 经皮冠状动脉介入 

分 类 号：R542.22[医药卫生—心血管疾病]