应用冠脉微循环阻力指数评价溶栓结合介入治疗的急性ST段抬高型心肌梗死患者预后的价值

武艳强; 侯爱军; 傅向华; 汪雁博; 傅阳; 冯强; 牛绍乾

doi:10.12125/j.chj.202103048

应用冠脉微循环阻力指数评价溶栓结合介入治疗的急性ST段抬高型心肌梗死患者预后的价值

Index of microcirculatory resistance postpercutaneous coronory intervention predicts infarction area and left ventricular function and prognosis in patients with thrombolyzed ST-segment elevation myocardial infarction

摘要

摘要:
目的应用冠脉微循环阻力指数（index of microcirculatory resistance,IMR）来评价溶栓结合经皮冠状动脉介入（PCI）治疗的急性ST段抬高型心肌梗死（STEMI）患者预后的价值。
方法 38例诊断为急性STEMI的患者首先接受静脉溶栓治疗后行PCI治疗，PCI术后即刻通过压力-温度导丝测定犯罪血管的冠脉血流贮备（coronary flow reserve，CFR）、血流贮备分数(fractional flow reserve，FFR)、IMR，评价术后心肌梗死溶栓试验（TIMI）、矫正的TIMI帧数（corrected TIMI frame count，CTFC），测量血清学标志及心电图ST回落（STR）情况、心肌梗死24 h内及3个月后行心脏超声评价心脏功能及结构。术后7 d常规行静息心肌核素检查，评价心脏IMR与左室心脏功能的关系。
结果溶栓联合介入干预治疗获得了良好的心肌灌注水平，术后90 %的患者达到TIMI血流3级，只有10 %的患者术后TIMI血流2级，无TIMI血流1级及0级的患者出现；术后IMR水平与与3个月后LVEF呈显著负相关（r=-0.419，P<0.01），以3个月后左室心脏功能的恢复与否作为因变量，以可能宿主因素和上述各观察指标为自变量代入Logistics回归模型，得出只有IMR可作为预测指标（P<0.01），OR值1.263（95%置信区间1.059~1.507），其IMR截断点为40.5，判断预后的灵敏度为90 %，特异度为65 %。
结论 IMR对评价溶栓结合PCI治疗STEMI患者3个月预后有较好的价值。

Abstract:
AIM To assess the predictive value of index of microcirculatory resistance (IMR) for left ventricular recovery in patients undergoing pharmacoinvasive strategy for st-segment elevation myocardial infarction (STEMI).
METHODS The index of microcirculatory resistance was assessed following percutaneous coronary intervention in 38 STEMI patients who were initially treated with thrombolysis. Other markers of microvascular functions such as coronary flow reserve (CFR), TIMI flow grade, corrected TIMI frame count (cTFC) and ST-segment resolution and markers of mycardial injury were also recorded. All indices were evaluated against 3-month post-operation left ventricular function, size of heart infarction and recovery.
RESULTS The pharmacoinvasive strategy achieved a good myocardial perfusion, with TIMI blood flow level 3 in 90% of the patients, TIMI blood flow level 2 in only 10% of the patients and no TIMI blood flow level 1 and 0. Postoperative IMR level was negatively correlated with LVEF 3 months after operation (r=-0.419, P<0.01). Taking 3-month post-operation recovery of left ventricular heart function as the dependent variable and possible factors and the above indicators as independent variables into the binary logistics regression model, only IMR could be used as the predictor (P<0.01), with OR value 1.263 (95% CI 1.059- 1.507). The cutoff point of IMR was 40.5, with prognostic sensitivity of 90% and specificity of 65%.
CONCLUSION IMR has a good value in assessing the 3-month post-operation prognosis of STEMI patients treated with thrombolysis combined with PCI.

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