摘要
目的探讨急性ST段抬高型心肌梗死(STEMI)接受经皮冠状动脉介入治疗(PCI)的患者冠状动脉造影衍生的微循环阻力指数(caIMR)升高的因素,并对其预后进行分析。方法回顾性纳入2018年1月至2022年1月北京大学人民医院心血管内科诊断为STEMI并行PCI的患者113例,依据术后caIMR值分为低caIMR组(caIMR<40 U,50例)和高caIMR组(caIMR≥40 U,63例),筛选出caIMR的独立危险因素,并对其1年内主要不良心血管事件(MACE)进行分析。结果与低caIMR组相比,高caIMR组超重/肥胖患者比例[45(71.4%)比24(48.0%),P=0.011]、肌钙蛋白I(TnI)峰值[46.06(25.11,80.90)pg/ml比67.63(32.94,143.81)pg/ml,P=0.018]、谷丙转氨酶[29.00(19.00,52.00)mmol/L比21.00(16.00,35.25)mmol/L,P=0.027]均显著升高,差异均有统计学意义。Logistic回归分析显示超重/肥胖(OR 3.263,95%CI 1.397~7.619,P=0.006)、TnI峰值(OR 1.007,95%CI 1.001~1.014,P=0.021)是caIMR升高的独立危险因素;低密度脂蛋白胆固醇(OR 0.586,95%CI 0.378–0.908,P=0.017)是caIMR升高的保护因素。高caIMR(OR 5.340,95%CI 1.121~25.449,P=0.035)、术前心绞痛(OR 0.144,95%CI 0.033~0.628,P=0.010)、左心室射血分数(OR 0.893,95%CI 0.827~0.965,P=0.004)是心力衰竭再住院的独立危险因素。结论STEMI患者行PCI后高caIMR组TnI峰值、超重/肥胖比例更高,心力衰竭再住院比例更高,提示可能远期预后不良。
Objective To investigate the factors of elevated coronary angiography-derived microcirculatory resistance index(caIMR)in patients with acute ST-segment elevation myocardial infarction(STEMI)with percutaneous coronary intervention(PCI),and to analyze its prognosis.Methods A total of 113 patients diagnosed with STEMI undergoing PCI from January 2018 to January 2022 were divided into two groups according to the postoperative caIMR value,low caIMR group(caIMR<40 U,n=50)and high caIMR group(caIMR≥40 U,n=63),independent risk factors for caIMR were screened,and major adverse cardiovascular events(MACE)within one year were analyzed.Results Compared with the low caIMR group,the proportion of overweight/obese patients[45(71.4%)vs.24(48.0%),P=0.011],troponin I(TnI)peak[46.06(25.11,80.90)pg/ml vs.67.63(32.94,143.81)pg/ml,P=0.018],and alanine aminotransferase[29.00(19.00,52.00)mmol/L vs.21.00(16.00,35.25)mmol/L,P=0.027]in the high caIMR group were signifi cantly increased.Logistic regression analysis showed that overweight/obesity(OR 3.263,95%CI 1.397–7.619,P=0.006),peak TnI(OR 1.007,95%CI 1.001–1.014,P=0.021)were independent risk factors for elevated caIMR.Low density lipoprotein cholesterol(OR 0.586,95%CI 0.378–0.908,P=0.017)is a protective factor for elevated caIMR.High caIMR(OR 5.340,95%CI 1.121–25.449,P=0.035),preoperative angina(OR 0.144,95%CI 0.033-0.628,P=0.010),and left ventricular ejection fraction(OR 0.893,95%CI 0.827–0.965,P=0.004)are independent risk factors for heart failure readmission.Conclusions Patients diagnosed STEMI and treated with PCI had higher TnI peaks and highter overweight/obesity ratios in the high caIMR group,and a higher readmission rate for heart failure,indicating a possible poor long-term prognosis.
作者
李妍博
侯昌
刘健
聂文畅
LI Yan-bo;HOU Chang;LIU Jian;NIE Wen-chang(Department of Cardiology,Peking University People’s Hospital,Beijing 100032,China)
出处
《中国介入心脏病学杂志》
CSCD
2023年第9期659-666,共8页
Chinese Journal of Interventional Cardiology
基金
国家自然科学基金重点项目(11832003)。
