冠状动脉微循环阻力评估急性ST段抬高型心肌梗死PCI患者预后的临床研究
Clinical study of coronary microcirculation resistance in predicting the prognosis of PCI patients with acute ST-segment elevation myocardial infarction
韩超 1张弘 1张慧 1安雯 1杨成昊 1张凌霄 1陈双宇 1郜俊清 1刘宗军1
作者信息
- 1. 上海中医药大学附属普陀医院(上海,200062)
- 折叠
摘要
目的:探讨冠状动脉(冠脉)微循环阻力评估急性ST段抬高型心肌梗死(STEMI)患者预后的价值.方法:本研究是一项前瞻性、观察性、单中心研究,纳入140例成功接受急诊经皮冠脉介入(PCI)治疗的STEMI患者,使用造影微循环阻力指数(CaIMR)分析罪犯血管和非罪犯血管的微循环阻力,其中诊断冠脉微血管功能障碍(CMD)61例(CMD组),诊断非CMD 79例(非CMD组).随访12个月,观察患者主要不良心血管事件(MACE,包括全因死亡、再次心肌梗死、因心衰住院及再次血运重建的复合结局)发生情况.采用Cox回归分析PCI术后1年MACE发生的预测因子.结果:CMD组MACE发生率显著高于非CMD组(10.13％vs 24.60％,P＜0.05).多因素 Cox 回归分析显示,术后 CaIMR(HR=5.887,95％CI:1.966～17.631,P＜0.002)、呋塞米使用(HR=4.38,95％CI:1.595～12.026,P=0.004)、肌钙蛋白(第 7 天)(HR=1.011,95％CI:1.003～1.018,P=0.004)以及 Killip 分级(HR=1.878,95％CI:1.28～2.756,P=0.001)是 STEMI 患者 PCI 术后 1 年内 MACE发生的独立预测因子.罪犯血管CMD与心血管性死亡、心衰发作以及主要不良事件发生率相关,非罪犯血管与各主要不良事件发生率无显著相关性.结论:STEMI患者PCI术后的CaIMR对临床预后具有很好的预测作用.
Abstract
Objective:To explore the value of coronary microcirculation resistance in evaluating the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:The study was a prospec-tive,observational,single-center study involving 140 STEMI patients who successfully received emergency percu-taneous coronary intervention(PCI)treatment.The contrast microcirculatory resistance index(CaIMR)was used to analyze the microcirculation resistance of culprit and non-culprit vessels,with 61 cases diagnosed with coronary microvascular dysfunction(CMD group)and 79 cases diagnosed with non-CMD(non-CMD group).Patients were followed up for 12 months to observe the occurrence of major adverse cardiovascular events(MACE,including all-cause mortality,myocardial infarction recurrence,hospitalization due to heart failure,and revascularization).The Cox regression model was used to analyze the predictors for MACE one year after PCI.Results:The incidence of MACE was significantly higher in the CMD group than in the non-CMD group(10.13％vs 24.60％,P＜0.05).Multivariate Cox regression analysis showed that postoperative CaIMR(HR=5.887,95％CI:1.966-17.631,P＜0.002),furosemide usage(HR=4.38,95％CI:1.595-12.026,P=0.004),troponin(on the 7th day)(HR=1.011,95％CI:1.003-1.018,P=0.004),and Killip grade(HR=1.878,95％CI:1.28-2.756,P=0.001)were independent predictors of MACE occurrence in one year after PCI in STEMI patients.Criminal vas-cular disease CMD was associated with cardiovascular death,heart failure attacks,and the incidence of major ad-verse events,while non-criminal blood vessels CMD was not significantly correlated with the incidence of major adverse events.Conclusion:CaIMR after PCI has a good predictive effect on the clinical prognosis in patients with acute STEMI.
关键词
冠脉微循环阻力指数/主要心血管不良事件/冠状动脉微循环功能障碍/急性ST段抬高型心肌梗死Key words
index of microcirculatory resistance/major adverse cardiovascular events/coronary microvascular dysfunction/ST-segment elevation myocardial infarction引用本文复制引用
基金项目
上海市"科技创新行动计划"医学创新研究专项(20Y11910100)
上海市"科技创新行动计划"医学创新研究专项(21Y11909600)
上海市"科技创新行动计划"医学创新研究专项(22Y11909600)
上海市普陀区卫生健康系统科技创新项目计划(ptkwws202320)
上海市普陀区卫生系统临床优势学科(2023ysxk01)
普陀区中心医院百人计划(2022-RCIC-01)
上海市第六人民医院医疗集团科学研究课题(21-ly-01)
成都中医药大学"杏林学者"学科人才科研提升计划(YYZX2022168)
出版年
2024
NETL
NSTL
万方数据