急性ST段抬高型心肌梗死直接介入术后恢复期心肌铁沉积的危险因素分析

Related factors of persistent iron in patients with acute ST-segment elevationmyocardial infarction after primary percutaneous coronary intervention

目的:探讨ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)后恢复期心肌铁沉积的危险因素。方法:前瞻性入选2019年10月至2021年9月,于北京安贞医院接受直接PCI且完成基线(术后3~7d)及恢复期(术后3~6个月)两次心脏磁共振(CMR)检查的STEMI患者。根据恢复期CMR图像是否存在铁沉积将患者分为两组,比较两组患者的临床特点并分析与恢复期铁沉积存在的相关危险因素。结果:共纳入148例患者,其中29例存在恢复期铁沉积。与恢复期不存在铁沉积的患者相比,恢复期存在铁沉积的患者中男性、高血压病史、前壁心肌梗死、术前TIMI血流0~1级的比例更高(P均<0.05)。多因素Logistic回归分析显示,既往高血压病史(OR=5.30,95%CI:1.64~17.09,P=0.005)、前壁梗死(OR=8.15,95%CI:1.76~37.62,P=0.007)、术前TIMI血流0~1级(OR=2.84,95%CI:1.08~7.48,P=0.034)是STEMI患者恢复期心肌存在持续铁沉积的危险因素。结论:高血压病史、前壁心肌梗死、术前TIMI血流0~1级是STEMI患者直接PCI术后恢复期心肌存在铁沉积的危险因素。

Objective:The current study aimed to investigate the risk factors of persistent iron in patients post-ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods:The STEMI patients who underwent primary PCI in Beijing Anzhen Hospital from October 2019 to September 2021 and underwent serial cardiovascular magnetic resonance at index admission(3 to 7 days)and 3 to 6 months after primary PCI were prospectively enrolled.The T2-weighted CMR imaging detected persistent iron on follow-up CMR.The patients were divided into two groups according to the presence or absence of persistent iron in follow-up CMR images,and clinical characteristics of both groups were compared.Logistic regression models were used to analyze the risk factors associated with persistent iron.Resultss:A total of 148 patients were included,and 29 of them had persistent iron.Compared with patients without persistent iron,the patients with persistent iron were higher proportions of male,a history of hypertension,anterior infarct location,and TIMI blood flow grade 0-1 pre-PCI(all P<0.05).Multivariate logistic regression analysis showed that the occurrence of persistent iron was associated with the history of hypertension(adjusted OR=5.30,95%CI:1.64-17.09,P=0.005),anterior infarct location(adjusted OR=8.15,95%CI:1.76-37.62,P=0.007),and TIMI blood flow 0-1 pre-PCI(adjusted OR=2.84,95%CI:1.08-7.48,P=0.034).Conclusions:Presence of persistent iron was associated with a history of hypertension,anterior infarct location,and TIMI blood flow 0-1 pre-PCI in STEMI patients after PPCI.