通过冠状动脉造影微循环阻力指数预测急性心肌梗死患者1年的心脏功能

To predict cardiac function at 1-year in patients with acute myocardial infarction by coronary angiography-derived index of microcirculatory resistance

目的通过冠状动脉造影微循环阻力指数(caIMR)评估急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后即刻与随访6个月时冠状动脉微循环功能的变化,进而预测患者术后1年心脏功能的变化。方法纳入TARGET STEMI OCT China研究中符合caIMR测量的患者30例,测量直接PCI术后即刻(caIMR0)及随访6个月(caIMR6)冠状动脉造影的caIMR值,通过线性回归方法分析冠状动脉微循环功能的变化对STEMI患者1年心脏功能的影响。结果30例患者caIMR0(41.70±12.22)U,caIMR6(28.74±10.05)U。caIMR6与caIMR0的差值△caIMR(–12.96±13.08)U。线性回归分析发现,△caIMR与术后1年的左心室射血分数(LVEF)呈负相关(P=0.023,r=–0.414),△caIMR对患者长期预后具有一定的预测价值。协方差分析发现,靶病变血管为左前降支(β=10.18,P=0.016)及新生内膜厚度(β=0.11,P=0.039)与caIMR6成正相关。结论STEMI患者△caIMR对术后1年的LVEF具有预测价值,二者成负相关。△caIMR越小时,术后1年的LVEF恢复越好。

Objective To predict the effect of microcirculation on 1-year cardiac f unction in ST-segment elevation myocardial infarction(STEMI)patients after stent implantation by measuring coronary angiography-derived index of microcirculatory resistance(caIMR)after immediately percutaneous coronary intervention(PCI)and 6 months follow�up.Methods Patients who met caIMR measurements in the TARGET STEMI OCT China trial were enrolled.CaIMR values were measured after immediately PCI(caIMR0)and at 6-month follow-up(caIMR6).Linear regression was used to analyze the effect of changes in coronary microcirculation function on 1-year cardiac function in STEMI patients.Results A total of 30 patients were enrolled.The caIMR0 was(41.70±12.22)U,and caIMR6 was(28.74±10.05)U.The△caIMR was(–12.96±13.08)U.Linear regression analysis showed that△caIMR was negatively correlated with 1-year left ventricular ejection fraction(P=0.023,r=–0.414),and△caIMR had a certain predictive value for long-term prognosis of STEMI patients.Covariance analysis showed that LAD and neointimal thickness were positively correlated with caIMR.Conclusions△caIMR has a predictive value for 1-year left ventricular ejection fraction in STEMI patients,and there is a negative correlation between them.The lower△caIMR is,the higher of 1-year LVEF.