溶栓后早期经皮冠状动脉介入对急性ST段抬高型心肌梗死患者心肌灌注及左心功能的影响

Impact of early percutaneous coronary intervention after thrombolysis on myocardial perfusion and left ventricular function in patients with acute ST-segment elevation myocardial infarction

扫码查看

原文链接

万方数据

中文摘要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者溶栓后早期经皮冠状动脉介入(PCI)对心肌灌注及左心功能的影响。方法前瞻性收集2020年1月至2022年12月于河北医科大学第二医院就诊的STEMI患者108例，分为溶栓后早期PCI组(65例)和直接PCI(pPCI)组(43例)。比较两组患者一般临床资料、PCI术后1 d及出院前常规超声心动图参数，应用心肌声学造影(MCE)评估PCI术后1 d及出院前心肌灌注情况。结果溶栓后早期PCI组及pPCI组一般临床资料差异无统计学意义(均P>0.05)。溶栓后早期PCI组及pPCI组患者出院前与PCI术后1 d相比左心室射血分数(LVEF)升高，差异有统计学意义(均P<0.05)。溶栓后早期PCI组与pPCI组相比出院前及PCI术后1 d LVEF差值变化差异有统计学意义(P<0.05)。与PCI术后1 d相比溶栓后早期PCI组及pPCI组出院前左心室整体纵向应变(LVGLS)升高(均P<0.05)。溶栓后早期PCI组与pPCI组相比出院前与PCI后1 d LVGLS差值变化差异有统计学意义(P<0.05)。溶栓后早期PCI组与pPCI组左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心房容积(LAV)、二尖瓣口舒张早期血流速度与舒张晚期血流速度比值(E/A)、二尖瓣环舒张早期运动速度的平均值(Em)及E/Em在PCI术后1 d及出院前差异无统计学意义(均P>0.05)。MCE显示，与PCI术后1 d相比，溶栓后早期PCI组与pPCI组在出院前MCE评分指数明显减低(均P<0.001)。与PCI后1 d相比，溶栓后早期PCI组在出院前心肌灌注正常(nMVP)比例升高，心肌灌注延迟(dMVP)及心肌微循环障碍(MVO)比例降低(均P<0.05)。与PCI后1 d相比，pPCI组出院前nMVP比例升高，dMVP比例降低(均P<0.05)，MVO比例减少但差异无统计学意义(P>0.05)。结论急性STEMI患者采用溶栓后早期PCI和直接PCI均可以改善左心室收缩功能及心肌灌注，溶栓后早期PCI在改善患者的左心室收缩功能及心肌灌注方面可能更具优势。 Objective To investigate the effects of early percutaneous coronary intervention (PCI) on myocardial perfusion and left ventricular function in patients with acute ST-segment elevation myocardial infarction (STEMI) after thrombolysis. Methods A total of 108 patients with STEMI treated in the Second Hospital of Hebei Medical University from January 2020 to December 2022 were divided into early PCI following thrombolysis group (n=65) and primary PCI (pPCI) group (n=43). The general clinical data, and the parameters of routine echocardiography at 1 day after PCI and before discharge were compared between the two groups. Myocardial contrast echocardiography (MCE) was used to evaluate myocardial perfusion at 1 day after PCI and before discharge. Results There were no significant differences in general clinical data between the early PCI following thrombolysis group and the pPCI group (all P>0.05). The left ventricular ejection fraction (LVEF) in the early PCI following thrombolysis group and pPCI group before discharge was significantly higher than that on the 1st day after PCI(bothP<0.05). The difference of LVEF was significant between the early PCI following thrombolysis group and the pPCI group before discharge and 1 day after PCI (P<0.05). Compared with 1 day after PCI, the global longitudinal strain (LVGLS) of left ventricle increased in early PCI following thrombolysis group and pPCI group before discharge(bothP<0.05). The difference of LVGLS between early PCI following thrombolysis group and pPCI group before discharge and 1 day after discharge was statistically significant(P<0.05). There were no significant differences in left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), left atrial volume (LAV), ratio of mitral early diastolic velocity to late diastolic velocity (E/A), mean early diastolic velocity of mitral annulus (Em) and E/Em 1 day after PCI and before discharge between early PCI following thrombolysis group and pPCI group (allP>0.05). MCE showed that the MCE score index of early PCI following thrombolysis group and pPCI group before discharge was significantly lower than that of 1 day after PCI(bothP<0.001). Compared to the 1 day after PCI, the early PCI following thrombolysis group showed a significant increase in the proportion of normal microvascular perfusion (nMVP) and a decrease in the proportion of delayed microvascular perfusion (dMVP) and microvascular obstruction (MVO) before discharge (allP<0.05). In contrast, the pPCI group demonstrated a significant decrease in the proportion of both nMVP and dMVP before discharge compared to the first day after PCI (allP<0.05). However, the decrease in the proportion of MVO was not statistically significant (P>0.05). Conclusions Early PCI following thrombolysis and pPCI can enhance left ventricular systolic function and myocardial perfusion in patients with acute ST-elevation myocardial infarction. Early PCI following thrombolysis may offer additional advantages in improving left ventricular systolic function and myocardial perfusion.

外文摘要：Objective To investigate the effects of early percutaneous coronary intervention (PCI) on myocardial perfusion and left ventricular function in patients with acute ST-segment elevation myocardial infarction (STEMI) after thrombolysis. Methods A total of 108 patients with STEMI treated in the Second Hospital of Hebei Medical University from January 2020 to December 2022 were divided into early PCI following thrombolysis group (n=65) and primary PCI (pPCI) group (n=43). The general clinical data, and the parameters of routine echocardiography at 1 day after PCI and before discharge were compared between the two groups. Myocardial contrast echocardiography (MCE) was used to evaluate myocardial perfusion at 1 day after PCI and before discharge. Results There were no significant differences in general clinical data between the early PCI following thrombolysis group and the pPCI group (all P>0.05). The left ventricular ejection fraction (LVEF) in the early PCI following thrombolysis group and pPCI group before discharge was significantly higher than that on the 1st day after PCI(bothP<0.05). The difference of LVEF was significant between the early PCI following thrombolysis group and the pPCI group before discharge and 1 day after PCI (P<0.05). Compared with 1 day after PCI, the global longitudinal strain (LVGLS) of left ventricle increased in early PCI following thrombolysis group and pPCI group before discharge(bothP<0.05). The difference of LVGLS between early PCI following thrombolysis group and pPCI group before discharge and 1 day after discharge was statistically significant(P<0.05). There were no significant differences in left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), left atrial volume (LAV), ratio of mitral early diastolic velocity to late diastolic velocity (E/A), mean early diastolic velocity of mitral annulus (Em) and E/Em 1 day after PCI and before discharge between early PCI following thrombolysis group and pPCI group (allP>0.05). MCE showed that the MCE score index of early PCI following thrombolysis group and pPCI group before discharge was significantly lower than that of 1 day after PCI(bothP<0.001). Compared to the 1 day after PCI, the early PCI following thrombolysis group showed a significant increase in the proportion of normal microvascular perfusion (nMVP) and a decrease in the proportion of delayed microvascular perfusion (dMVP) and microvascular obstruction (MVO) before discharge (allP<0.05). In contrast, the pPCI group demonstrated a significant decrease in the proportion of both nMVP and dMVP before discharge compared to the first day after PCI (allP<0.05). However, the decrease in the proportion of MVO was not statistically significant (P>0.05). Conclusions Early PCI following thrombolysis and pPCI can enhance left ventricular systolic function and myocardial perfusion in patients with acute ST-elevation myocardial infarction. Early PCI following thrombolysis may offer additional advantages in improving left ventricular systolic function and myocardial perfusion.

外文关键词：

EchocardiographyAcute ST-segment elevation myocardial infarctionEarly percutaneous coronary intervention following thrombolysisMyocardial perfusionVentricular function, leftMyocardial contrast echocardiography

作者：

苗雅敬、王晓旭、汪雁博、韩高洁、仝巧立、张旭倩、吴敬兰、谷新顺、尹洪宁

展开 >

作者单位：

河北医科大学第二医院心脏超声科，石家庄　050000

河北医科大学第二医院心血管内科，石家庄　050000

关键词：

超声心动描记术急性ST段抬高型心肌梗死溶栓后早期经皮冠状动脉介入心肌灌注心室功能,左心肌声学造影

基金：

河北省重点研发计划

项目编号：

20377762D

出版年：

2024

DOI：

10.3760/cma.j.cn131148-20231009-00154

中华超声影像学杂志

中华医学会

中华超声影像学杂志

CSTPCD北大核心

影响因子：0.986

ISSN：1004-4477

年,卷(期)：2024.33(2)

参考文献量16