PCI后患者复发性心绞痛与心肌微循环的相关性分析

Correlation between recurrent angina pectoris and myocardial microcirculation in patients after percutaneous coronary intervention

目的探讨急性心肌梗死患者经皮冠状动脉介入治疗(PCI)后心绞痛复发与心肌微循环的相关性。方法回顾性纳入2016年4月至2019年4月于秦皇岛市第一医院心内科行PCI的182例急性心肌梗死患者作研究对象,根据随访1年中有无心绞痛复发分为复发组(48例)与对照组(134例)。采用Kaplan-Meier法分析不同微循环阻力指数(IMR)、冠状动脉血流储备(CFR)患者1年内心绞痛复发率,Logistic回归分析心绞痛复发相关因素。结果复发组低密度脂蛋白胆固醇(LDL-C)和IMR高于对照组,Killip分级≤Ⅱ级例数和CFR低于对照组(P均<0.05);IMR<25 U的患者心绞痛复发风险显著低于IMR≥25U者,CFR>2.9的患者心绞痛复发风险显著低于CFR≤2.9者(P均<0.001);LDL-C(OR=1.930,95%CI:1.229~3.032,P=0.004)和IMR(OR=1.283,95%CI:1.175~1.402,P<0.001)为心绞痛复发的危险因素,入院时Killip分级≤Ⅱ级(OR=0.248,95%CI:0.085~0.722,P<0.001)和CFR(OR=0.228,95%CI:0.082~0.634,P=0.005)为心绞痛复发的保护因素。结论急性心肌梗死患者PCI后心肌微循环情况与心绞痛复发相关,监测术后IMR和CFR或有助于预测患者预后。

Objective To discuss the correlation between recurrent angina pectoris(AP)and myocardial microcirculation in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods AMI patients(n=182)undergone PCI were retrospectively chosen from Department of Cardiology in the First Hospital of Qinhuangdao City from Apr.2016 to Apr.2019.After followed up for 1 y,all patients were divided into recurrent group(n=48)and control group(n=134).The index of microcirculatory resistance(IMR),coronary flow reserve(CFR)and recurrent rate of AP within 1 y were analyzed by using Kaplan-Meier method,and related factors of AP recurrence were analyzed by using Logistic regression analysis.Results The levels of LDL-C and IMR were higher,and cases of Killip grade≤Ⅱand CFR were lower in recurrent group than those in control group(all P<0.05).The risk of AP recurrent was significantly lower in patients with IMR<25U than that in patients with IMR≥25U,and was significantly lower in patients with CFR>2.9 than that in patients with CFR≤2.9(all P<0.001).LDL-C(OR=1.930,95%CI:1.229~3.032,P=0.004)and IMR(OR=1.283,95%CI:1.175~1.402,P<0.001)were risk factors of AP recurrence.Killip grade≤Ⅱ(OR=0.248,95%CI:0.085~0.722,P<0.001)and CFR(OR=0.228,95%CI:0.082~0.634,P=0.005)at hospitalization time were protective factors of AP recurrence.Conclusion The myocardial microcirculation after PCI is correlated to AP recurrence in AMI patients,and monitoring of IMR and CFR is perhaps beneficial to predict patients'prognosis.