IMR预测心肌梗死患者PCI术后心脏不良事件的临床研究

Clinical study on microcirculation resistance index for predicting major adverse cardiac events after PCI operation in patients with ST segment elevation myocardial infarction

目的探讨微循环阻力指数(IMR)对ST段抬高型心肌梗死PCI术后主要心脏不良事件的预测价值。方法选择ST段抬高型心肌梗死(STEMI)患者48例(男38例,女10例),根据PCI术后测量的IMR值分为3组,A组IMR≤25(n=18);B组IMR 25~32(n=16);C组IMR≥32(n=14)。检测血清N末端B型脑钠肽前体(NT-ProBNP),PCI术后及术后1年心脏彩超左室射血分数(LVEF)、左室舒张末内径(LVEDD),术后1年内的主要心脏不良事件。结果3组间血清NT-ProBNP水平[(2 734.83±1 009.40)vs.(4 929.68±1 611.52)vs.(7 480.64±2 082.78)]比较,差异有统计学意义(F=35.449,P=0.000)。术后3组间LVEF[(54.00±5.99)vs.(52.31±4.35)vs.(49.29±4.68)]比较,差异具有统计学意义(F=3.376,P=0.043),3组间LVEDD差异无统计学意义(P>0.05);术后1年3组间LVEF[(57.28±5.21)vs.(54.43±3.69)vs.(46.43±5.33)]比较,差异有统计学意义(F=16.744,P=0.000),3组间LVEDD(48.94±1.95)vs.(50.63±2.68)vs.(52.14±2.69)比较,差异具有统计学意义(F=6.875,P=0.002)。术后1年内心脏不良事件,发生心源性死亡、心力衰竭例数3组间差异均有统计学意义(χ~2=6.707,P=0.035;χ~2=6.084,P=0.048);再次ACS、再次PCI及恶性心律失常的发生情况差异均无统计学意义(P>0.05)。结论STEMI PCI术后测量IMR能有效预测患者心功能及1年内发生主要心脏不良事件的风险。

Objective To investigate the clinical value of the index of microcirculation resistance（IMR）in the prediction of major adverse cardiac events after PCI in the patients with ST segment elevation myocardial infarction.Methods Forty-eight inpatients with acute ST segment elevation myocardial infarction（STEMI）in the cardiology department CCU of our hospital from December 2013 to June 2015 were selected,including 38 males and 10 females,and divided into 3groups according to the measured IMR value after PCI operation：the group A,IMR≤25（n=18）;group B,IMR 25~32（n=16）;group C,IMR≥32（n=14）.Serum NT-ProBNP was collected,and the data in cardiac color ultrasound after PCI and at postoperative 1year：left ventricular ejection fraction（LVEF）and left ventricular end diastolic diameter（LVEDD）,and major adverse cardiac events within 1years after PCI were also collected.Results The serum of concentrations NT-ProBNP were compared among the three groups[（2 734.83±1 009.40）vs.（4 929.68±611.52）vs.（7 480.64±2 082.78）],and the difference among 3groups was statistically significant（F=35.449,P=0.000）.The difference of LVEF among the three groups had statistal significance[（54.00±5.99）vs.（52.31±4.35）vs.（49.29±4.68）,F=3.376,P=0.043）],and there was no statistical difference among the three groups in LVEDD（P〈0.05）.The difference of LVEF at postoperative 1year among 3groups had statistical significance[（57.28±5.21）vs.（54.43±3.69）vs.（46.43±5.33）,F=16.744,P=0.000],and the difference of LVEDD（48.94±1.95）vs.（50.63±2.68）vs.（52.14±2.69）among3groups was statistically significant（F=6.875,P=0.002）.The differences in the major adverse cardiac events,cases of cardiac death and cases of heart failure after postoperative 1year among 3groups were statistically significant（χ~2 value=6.707,P=0.035;χ~2 value=6.084,P=0.048）;the occurrence of again ACS,again PCI and malignant arrhythmia had no statistical difference among 3groups（P〈0.05）.Conclusion Measurement of IMR after PCI in the patients with STEMI can effectively predict the heart function and the risk of major adverse cardiac events within 1year.