微血管阻力指数和冠状动脉血流储备对急诊PCI患者的术后评估价值

The evaluation of microvascular resistance index and coronary blood flow reserve in emergency PCI patients

目的探讨急性ST段抬高型心肌梗死患者通过经皮冠状动脉介入治疗(PCI)后,检测微循环阻力指数(IMR)和冠状动脉血流储备(CFR),通过IMR进行分级评估术后该指标与患者健康状况的关系。方法ST段抬高型心肌梗死患者按IMR(≤40或>40)进行分级。心肌梗死后7 d内及6个月后进行心脏磁共振成像,并保持随访。结果IMR>40时患者心肌出血发生风险显著增加(P=0.001);IMR>40与CFR≤2.0联合与微血管阻塞显著相关(P<0.05),与心肌出血无关(P=0.104);IMR≤40和CFR≤2.0联合与微血管阻塞和心肌缺血发生风险均显著相关(P<0.05)。多因素分析显示,基线左心室舒张末期容积(LVEDV)、梗死面积、体质量指数、高胆固醇血症、男性、IMR>40、糖尿病史与6个月时LVEDV变化显著相关(P<0.05)。结论IMR>40与ST段抬高型心肌梗死后LVEDV变化和临床预后相关联,与梗死面积无关。IMR具有较好的风险分层临床价值,可为心肌再灌注失败检测提供参考。

Objective To investigate the relationship between microcirculation resistance index(IMR)and coronary flow reserve(CFR)in patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods Patients with ST segment elevation myocardial infarction(STEMI)were classified according to IMR(≤40 or>40).Magnetic resonance imaging was performed within 7 days and 6 months after myocardial infarction Results When IMR>40,the risk of myocardial hemorrhage was significantly increased(P=0.001);The combination of IMR>40 and CFR≤2.0 was significantly associated with microvascular occlusion(P<0.05),but not with myocardial hemorrhage(P=0.104);IMR≤40 and CFR≤2.0 were significantly associated with the risk of microvascular occlusion and myocardial ischemia(P<0.05).Multivariate analysis showed that baseline LVEDV,infarct size,BMI,hypercholesterolemia,male,IMR>40 and diabetes were significantly correlated with LVEDV at 6 months(P<0.05).Conclusion IMR>40 was associated with LVEDV changes and clinical prognosis after ST segment elevation myocardial infarction,but not with infarct size.IMR has a good clinical value in risk stratification,and can provide a reference for the detection of myocardial reperfusion failure.