经皮冠状动脉介入术相关的围手术期心肌梗死对远期心功能的影响

Effect of periprocedural myocardial injury related to percutaneous coronary intervention on cardiac function

目的：观察经皮冠状动脉介入术（PCI）相关的围手术期心肌损伤患者血清脑钠肽（BNP）和心功能的变化,并评估围手术期心肌梗死对远期心功能的影响。方法：根据1 187例行PCI的冠心病患者术前、术后12~24 h血清心肌钙蛋白I（cTn I）分为无心肌损伤组、心肌损伤组和心肌梗死组。检测术前、术后3~6 h、12~24 h的血清BNP,比较术前、术后1年的超声心动图左心室射血分数（LVEF）值及舒张早期左房室瓣血流速度与舒张晚期左房室瓣血流速度比值（E/A值）。观察再次入院率、再次心肌梗死及再次血管重建的发生率。结果：PCI相关心肌梗死的发生率为8.59%（102例）,心肌损伤的发生率为14.15%（168例）。心肌梗死组PCI术前及术后3~6 h、12~24 h血清BNP分别为（30±22）、（70±36）、（211±59）ng/L;心肌损伤组为（33±23）、（57±29）、（118±60）ng/L;无心肌损伤组为（32±33）、（42±38）、（66±55）ng/L。术后BNP水平较术前显著上升（P〈0.05）,且心肌梗死组和心肌损伤组术后BNP水平高于无心肌损伤组（P〈0.05）。PCI术后1年心肌梗死组和心肌损伤组的LVEF及E/A值均低于无心肌损伤组（LVEF分别为55%±6%、63%±5%、65%±4%,P〈0.05;E/A值分别为0.69±0.15、0.82±0.14、1.13±0.07,P〈0.05）。1年的随访中,因心绞痛或心力衰竭再次入院率、再次心肌梗死及再次血管重建的发生率在3组中有显著差异（P〈0.05）,在心肌梗死组为8.80%、1.96%、3.92%,发生率最高;3组均未在随访期间发生死亡事件。结论：PCI相关的围手术期心肌梗死可能导致远期心功能的下降,24 h内的血清cTn值和血清BNP水平的上升可能作为远期心功能的预测因子。

Objective To observe the changes of brain natriuretic peptide （BNP） and cardiac function in patients with periprocedural myocardial injury related to percutaneous coronary intervention （PCI）, and to evaluate the long term effect of periprocedural myocardial injury on cardiac function. Methods One thousand one hundred and eighty-seven patients undergoing elective PCI were divided into non-myocardial injury group, myocardial injury group and myocardial infarction group according to levels of cardiactroponin-I （cTn I） before and during 12-24 h after PCI. Serum levels of BNP before and 3-6 h, 12-24 h after PCI were determined. The value of left ventricular ejection fraction （LVEF） and ratio of early to late diastolic filling （E/A） by echocardiography before and 1 year after PCI were compared. The re-admission rate, incidence of myocardial infarction and revascularization rate after PCI were analyzed. Results The incidence of PCI related myocardial infarction was 8.59% （102）, and incidence of PCI related myocardial injury was 14.15% （168）.Levels of BNP in myocardial infarction group increased significantly at 3-6 h, 12-24 h after PCI [（30±22）, （70±36）, （211±59） ng/L, respectively, P〈0.05]; levels of BNP in myocardial injury group before and 3-6 h, 12-24 h after PCI were （33±23）, （54±29）, （118±60） ng/L, respectively （P〈0.05）; levels of BNP in non-myocardial injury group before and 3-6 h, 12-24 h after PCI were （32±33）, （42±38）, （66±55） ng/L, respectively （P〈0.05）. LVEF in myocardial infarction group and myocardialgroup was lower than non-myocardial injury group after PCI （55%±6%, 63%±5%, 65%±4%, respectively, P〈0.05）, E/A was also lower than non-myocardial injury group after PCI （0.69±0.15, 0.82±0.14, 1.13±0.07 ,respectively, P〈0.05）. During 1 year follow-up, the incidence of re-admission due to angina or heart failure , myocardial infarction, and revascularization in three groups were different significantly （P〈0.05）. The incidence was the highest in myocardial infarction group （8.80%, 1.96%, 3.92%, respectively）. There was no death during 1 year follow-up. Conclusions Periprocedural myocardial injury lead to decline in cardiac function. The level of cTn combined with BNP could predict the risk of decline in cardiac function.