首页|急性心肌梗死患者急诊经皮冠状动脉介入治疗术后发生冠状动脉微循环障碍的早期临床预测技术研究

急性心肌梗死患者急诊经皮冠状动脉介入治疗术后发生冠状动脉微循环障碍的早期临床预测技术研究

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目的 探讨左室整体纵向应变(LVGLS)联合全球急性冠状动脉事件注册(GRACE)评分预测急诊经皮冠状动脉介入治疗(PCI)术后急性心肌梗死(AMI)患者发生冠状动脉微循环障碍(CMD)的临床价值。方法 选取收治的AMI患者90例为研究对象(失访10例，图像质量差筛除4例)，最终纳入76例。术后48 h，患者接受左室心肌声学造影(MCE)技术检测。将患者根据冠状动脉微循环灌注情况分为非CMD组(n=53)及CMD组(n=23)。分析比较2组临床数据及超声心动图相关数据。采用多因素Logistic回归分析筛选CMD发生的影响因素，并绘制受试者工作特征(ROC)曲线分析其临床预测价值。结果 76例患者中，发生CMD 23例(30。26％)o CMD组的LVGLS、GRACE评分高于非CMD组，差异有统计学意义(P＜0。05)。多因素Logistic回归分析显示，LVGLS、GRACE评分是急诊PCI术后AMI患者发生CMD的独立预测因子。LVGLS预测CMD发生的曲线下面积为0。858(95％CI:0。769～0。948)。LVGLS联合GRACE评分预测CMD发生的曲线下面积为0。891(95％CI:0。815～0。967)。结论 LVGLS是早期评估急诊PCI术后AMI患者CMD发生的独立预测因素，其协同GRACE评分可以提高预测CMD发生的准确性。
Early clinical prediction of coronary microcirculation disturbance after emergency percutaneous coronary intervention in patients with acute myocardial infarction
Objective To investigate the clinical value of left ventricular global longitudinal strain(LVGLS)combined with the global register of acute coronary events(GRACE)score in predic-ting coronary microcirculation disorder(CMD)in patients with acute myocardial infarction(AMI)af-ter emergency percutaneous coronary intervention(PCI).Methods A total of 90 patients with AMI were selected as the study objects(10 cases were lost in follow-up,4 cases were screened for poor im-age quality),and 76 cases were finally included.Left ventricular myocardial contrast echocardio-graphy(MCE)was performed in patients at 48 h after surgery.Patients were divided into non-CMD group(n=53)and CMD group(n=23)according to coronary microcirculation perfusion.Clinical data and echocardiographic data of the two groups were analyzed and compared.Multivariate Logistic regression analysis was used to screen the influencing factors of CMD occurrence,and receiver operat-ing characteristic(ROC)curve was drawn to analyze its clinical predictive value.Results Of the 76 patients,23(30.3％)cases had CMD.LVGLS and GRACE scores in the CMD group were higher than those in the non-CMD group,and the differences were statistically significant(P＜0.05).Multi-variate Logistic regression analysis showed that LVGLS and GRACE score were independent predictors of CMD in AMI patients after emergency PCI.The area under the curve of CMD predicted by LVGLS was 0.858(95％CI,0.769 to 0.948).LVGLS combined with GRACE predicted that the area un-der the curve for CMD was 0.891(95％CI,0.815 to 0.967).Conclusion LVGLS is an inde-pendent predictor for early assessment of CMD occurrence in AMI patients after emergency PCI,and its combination with GRACE score can improve the accuracy of predicting CMD occurrence.

left ventricular global longitudinal strainmyocardial contrast echocardiographyglobal register of acute coronary eventsacute myocardial infarctioncoronary microcirculation disorder

王莉、吴春苑、匡龙、宋佳贤、任骋、徐芳

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苏州大学附属张家港医院心血管内科,江苏张家港,215600

左室整体纵向应变 心肌声学造影 全球急性冠状动脉事件注册 急性心肌梗死 冠状动脉微循环障碍

江苏省苏州市指导性项目江苏省张家港市科技计划

SYSD2018004ZKYL2341

2024

10.7619/jcmp.20233267

实用临床医药杂志
扬州大学,中国高校科技期刊研究会

实用临床医药杂志

CSTPCD
影响因子：1.543
ISSN：1672-2353
年,卷(期)：2024.28(3)
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