首页|冠状动脉造影微循环阻力指数对急性ST段抬高型心肌梗死患者急诊PCI术后预后的评估价值

冠状动脉造影微循环阻力指数对急性ST段抬高型心肌梗死患者急诊PCI术后预后的评估价值

Prognostic Values of caIMR for the Prognosis of Patients with STEMI after Primary PCI

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  • 维普
  • 万方数据
目的 探究冠状动脉造影微循环阻力指数(coronary angiography-derived index of microcirculatory resistance,caIMR)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后发生主要心血管不良事件(major adverse cardiovascular events,MACE)的预测价值.方法 连续纳入2019年9月～2022年3月在徐州医科大学附属医院诊断为STEMI的患者541例.使用FlashAngio系统(苏州润迈德医疗科技有限公司)计算caIMR.按照住院或随访期间MACE发生与否将患者分为MACE组和非MACE组,MACE定义为全因死亡、心力衰竭再入院、非计划性血运重建.采用COX回归分析、受试者工作特征(receiver operating characteristics,ROC)曲线、Kaplan-Meier 生存曲线探究 caIMR 对 STEMI患者急诊PCI术后预后的评估价值.结果 随访时间为1年,其中发生MACE 61例(11.28％).与非MACE组比较,MACE组患者有着更高的caIMR.多因素COX分析表明,caIMR是MACE的独立危险因素.ROC曲线分析结果显示,caIMR预测MACE的曲线下面积0.688,最佳截断值为25.3 U.caIMR加入到临床危险因素模型中后显著增加了模型的判别和重新分类能力;进一步将患者分为低caIMR组(caIMR＜25 U,n=377)和高caIMR组(caIMR≥25 U,n=164).Kaplan-Meier曲线显示caIMR≥25 U患者预后更差.结论 caIMR是STEMI患者行PCI术后预后不良的独立危险因素,caIMR≥25 U患者预后更差.
Objective To explore the prognostic value of the coronary angiography-derived index of microcirculatory resistance(caIMR)for major adverse cardiovascular events(MACE)in patients with acute ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods Between September 2019 and March 2022,541 patients diagnosed with STEMI at the Affiliated Hospital of Xuzhou Medical University were enrolled.The caIMR was calculated using the FlashAngio system(Suzhou Rainmed Medical Technology Co.,Ltd.).The patients were divided into MACE and non-MACE groups according to the occurrence of MACE during hospitalization or follow-up,with MACE defined as all-cause mortality,heart failure readmission,and unplanned revascularization.COX regression analysis,receiver operating characteristic(ROC)curves,and Kaplan-Meier survival curves were used to evaluate the prognostic value of caIMR for STEMI patients after primary PCI.Results During the 1-year follow-up,61 patients(11.28％)experienced MACE.The patients in the MACE group had higher caIMR values than those in the non-MACE group.Multivariate COX analysis showed that caIMR was an independent risk factor for MACE.ROC curve analysis showed that caIMR predicted MACE with an area under the curve of 0.688,and the optimal cutoff value was 25.3 U.caIMR significantly increased the discriminant and reclassification indexes when added to a model with clinical risk factors.The patients were further divided into a low caIMR group(caIMR＜25 U,n=377)and a high caIMR group(caIMR ≥25 U,n=164).Kaplan-Meier curve showed that patients with caIMR≥25 U had a worse prognosis.Conclusions caIMR is an independent risk factor for poor prognosis after PCI in patients with STEMI,and patients with caIMR≥25 U had a worse prognosis.

acute ST-segment elevation myocardial infarction(STEMI)coronary angiography-derived index of microvascular resistance(caIMR)primary percutaneous coronary intervention(PCI)coronary microvascular dysfunction(CMD)major adverse cardiovascular events(MACE)

伍逸轩、陈磊、任燕飞、杨玉琳、陆远

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徐州医科大学附属医院心血管内科,江苏徐州 221002

徐州医科大学第一临床医学院,江苏徐州 221002

急性ST段抬高型心肌梗死 冠状动脉造影微循环阻力指数 急诊经皮冠状动脉介入术 冠状动脉微循环功能障碍 主要心血管不良事件

江苏省卫生健康委员会医学科研立项项目

M2021046

2024

10.16156/j.1004-7220.2024.02.023

医用生物力学
上海第二医科大学

医用生物力学

CSTPCD北大核心
影响因子：0.858
ISSN：1004-7220
年,卷(期)：2024.39(2)
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