STEMI患者冠状动脉非罪犯血管狭窄血流动力学模式对远期预后的影响  

Impact of hemodynamic pattern of non-culprit vessel stenosis on the long-term prognosis in patients with acute ST-segment elevation myocardial infarction

作　　者：耿亮 周林[1] 王兴旭 游洁芸 俞帅 韦苇 李纪明 高力明 汪云开 郭蔚 黄瑛 张奇 Geng Liang;Zhou Lin;Wang Xingxu;You Jieyun;Yu Shuai;Wei Wei;Li Jiming;Gao Liming;Wang Yunkai;Guo Wei;Huang Ying;Zhang Qi(Department of Cardiology,East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属上海市东方医院心脏内科,上海200120

出　　处：《中华心血管病杂志》2025年第3期260-267,共8页Chinese Journal of Cardiology

基　　金：上海市浦东新区卫生系统重点学科群建设(PWZxq2022-02)。

摘　　要：目的 探讨急性ST段抬高型心肌梗死(STEMI)患者中冠状动脉非罪犯血管狭窄血流动力学模式与远期血管导向复合终点(VOCO)事件的相关性。方法 本研究为前瞻性队列研究, 连续选取2019年1月至2021年12月上海市东方医院合并非罪犯血管狭窄的STEMI患者233例, 随访中位时间为3.9年。根据随访结果将233例患者的367条非罪犯血管分为VOCO组(33条血管, 9.0%)和非VOCO组(334条血管, 91.0%), 比较2组冠状动脉狭窄血流动力学模式相关参数的差异。应用受试者工作特征曲线评估定量血流分数(QFR)最大下降梯度(dQFR/dsmax)与VOCO的相关性, 并采用多因素Cox以及logistic回归分析VOCO的独立预测因素。结果 纳入的233例患者年龄(62.5±12.9)岁, 男性193例(82.8%)。VOCO组QFR检测节段20 mm内QFR下降最大值、全血管QFR差值、有功能学意义血管长度以及dQFR/dsmax均大于非VOCO组(P均<0.05)。受试者工作特征曲线分析显示, dQFR/dsmax预测VOCO的最佳阈值为0.009 6(曲线下面积=0.691, 95%CI:0.606~0.775, P<0.001)。多因素Cox回归分析显示, 高dQFR/dsmax是VOCO的独立预测因素(HR=1.199, 95%CI:1.070~1.343, P=0.002)。将解剖以及功能性狭窄程度纳入模型后, 高压力回撤梯度(PPG)指数(HR=1.572, 95%CI:1.052~2.351, P=0.027)是VOCO的独立预测因素。多因素logistic回归分析显示低PPG指数(OR=2.851, 95%CI:1.945~4.178, P<0.001)是QFR≤0.80且未发生远期VOCO事件的独立预测因素。结论 STEMI患者中局限性的非罪犯血管狭窄血流动力学模式(高dQFR/dsmax和高PPG指数)与远期VOCO相关。Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(vocoO)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From January 2019 to December 2021,233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital.The median follow-up duration was 3.9 years.The 367 non-culprit vessels of the 233 patients were divided into the V0CO group(33 vessels,9.0%)and the non-vVocO group(334 vessels,91.0%).Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared.Receiver operating characteristic(ROC)curves were used to assess the correlation between hemodynamic pattern and VocO,and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOco.Results The 233 enrolled patients were aged(62.5±12.9)years,with 193 males(82.8%).In the V0CO group,the maximum quantitative flow ratio(QFR)decreased within 20 mm of the QFR-assessed segment,the difference in QFR across the entire vessel,the length of functionally significant vessel,and the maximum gradient of QFR decrease(dQFR/dsmax)were significantly greater than those in the non-VOCO group.ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.0096(area under the curve:0.691,95%Cl:0.606-0.775,P<0.001).Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO(HR=1.199,95%Cl:1.070-1.343,P=0.002).When anatomical and functional stenosis severities were included in the model,a high pullback pressure gradient(PPG)index(HR=1.572,95%Cl:1.052-2.351,P=0.027)emerged as an independent predictor of VOCO.Multivariable logistic regression analysis revealed that a low PPG index(0R=2.851,95%CI:1.945-4.178,P<0.001)was an independent predictor of QFR<0.80 without long-term Voco.Conclusion In patients with STEMI,loca

关 键 词：心肌梗死 急性ST段抬高型心肌梗死 非罪犯血管狭窄 定量血流分数 冠状动脉狭窄血流动力学模式 

分 类 号：R54[医药卫生—心血管疾病]