摘要
目的 探讨血运重建时机对急性心肌梗死(AMI)患者血管再通率、心肌微循环、心功能及预后的影响.方法 选取2019 年1 月—2021 年6 月收治的556 例AMI,根据血运重建时机分为早期组和晚期组各278 例.早期组入院12～＜24 h行血运重建,晚期组入院24～＜72 h行血运重建.比较2 组血管再通率和治疗前、治疗后7d、治疗后3 个月心肌微循环指标[造影剂开始灌注时间(AT)、灌注达峰时间(APT)、灌注峰值强度(PI)、曲线上升斜率(β)、心肌血流量(MBF)]、心肌损伤指标[血清肌钙蛋白I(cTnI)、心肌型肌酸激酶同工酶(CK-MB)、N末端脑钠肽前体(NT-proBNP)]、血管内皮功能指标[血清内皮细胞特异性分子-1(ESM-1)、内皮素-1(ET-1)、一氧化氮(NO)]水平,以及治疗前、治疗后3 个月心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVDs)、左心室舒张末期内径(LVDd)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)],并统计2 组治疗后6 个月预后情况.结果 早期组血管再通率(96.40%,268/278)高于晚期组(90.29%,251/278)(P＜0.01).治疗后7d、治疗后3 个月早期组AT、APT、PI、β、cTnI、CK-MB、NT-proBNP、ESM-1、ET-1 低于晚期组,MBF、NO高于晚期组(P＜0.01);治疗后 3 个月早期组LVEF高于晚期组,LVDs、LVDd、LVESV、LVEDV低于晚期组(P＜0.01).早期组治疗后 6 个月主要心血管不良事件(MACE)发生率低于晚期组(P＜0.05).结论 入院 12～＜24 h行血运重建能显著提高AMI患者血管再通率,改善心肌微循环,促进心肌损伤修复,纠正血管内皮功能紊乱,加快心功能恢复,且MACE发生风险较低.
Abstract
Objective To investigate the effects of revascularization timing on vascular revascularization rate,myo-cardial microcirculation,cardiac function and prognosis in patients with acute myocardial infarction(AMI).Methods A to-tal of 556 patients with AMI treated from January 2019 to June 2021 were selected and divided into early stage group(n = 278)and late stage group(n =278)according to the timing of revascularization.The early stage group underwent revascular-ization within 12 to 24 h after admission,and the late stage group underwent revascularization within 24 to 72 h after admis-sion.The rate of vascular revascularization,myocardial microcirculation indicators[starting time of contrast agent perfusion(AT),time to peak perfusion(APT),peak perfusion intensity(PI),curve rise slope(β),myocardial blood flow(MBF)],myocardial injury indicators[cardiac troponin I(cTnI),myocardial creatine kinase isoenzyme(CK-MB),N-terminal pro-brain natriuretic peptide(NT-proBNP)],vascular endothelial function indicators[serum endothelial cell spe-cific molecule-1(ESM-1),endothelin-1(ET-1),nitric oxide(NO)]before treatment,at 7 d and 3 months after treatment was compared between the two groups,and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventric-ular end-systolic diameter(LVDs),left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic volume(LVESV),and left ventricular end-diastolic volume(LVEDV)]were also analyzed before treatment and at 3 months after treatment.Results The rate of vascular revascularization in early stage group(96.40%,268/278)was higher than that in late stage group(90.29%,251/278),with significant difference(P＜0.01).AT,APT,PI,β,cTnI,CK-MB,NT-proBNP,ESM-1 and ET-1 in early stage group were lower than those in late stage group at 7 d and 3 months after treat-ment,while MBF and NO were higher than those in late stage group(P＜0.01).At 3 months after treatment,LVEF in early stage group was higher than that in late stage group,while LVDs,LVDd,LVESV and LVEDV were lower than those in late stage group(P＜0.01).The incidence of major adverse cardiovascular events(MACE)at6 months after treatment in the early stage group was lower than that in the late stage group(P＜0.05).Conclusion Revascularization within12 to24 h af-ter admission can significantly increase the rate of vascular revascularization in AMI patients,improve myocardial microcircula-tion,promote myocardial damage repair,correct vascular endothelial dysfunction,accelerate cardiac function recovery,and lower the risk of major adverse cardiovascular events.
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