冠状动脉周围脂肪组织厚度对STEMI患者PCI术后远期预后的影响

Effect of pericoronary adipose tissue thickness on the long-term prognosis of STEMI patients after PCI

目的探讨冠状动脉周围脂肪组织厚度对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后远期预后的预测价值。方法回顾性收集2019年10月—2021年10月首次发生STEMI于南京鼓楼医院接受PCI并且术后行心脏磁共振检查的患者195例,收集患者一般资料、实验室检验结果及心脏磁共振指标。所有患者出院后随访12个月,根据后续有无主要不良心血管事件(MACE)发生分为MACE组及非MACE组。采用logistic回归分析判断患者发生MACE的独立危险因素。采用受试者工作特征(ROC)曲线分析冠状动脉周围脂肪组织厚度及其他指标对患者MACE发生的预测作用。结果MACE组在年龄、肌钙蛋白T及B型利尿钠肽(BNP)水平、左室射血分数(LVEF)、左心室梗死面积、微血管阻塞(MVO)、前室间沟脂肪组织厚度指数(SIVGi)与非MACE组相比,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示即使在其他危险因素调整后,SIVGi增加(OR=2.742,95%CI 1.763~4.266,P<0.001)仍是STEMI患者术后发生MACE的独立危险因素,LVEF增加(OR=0.852,95%CI 0.775~0.935,P=0.001)则是保护因素。SIVGi联合LVEF预测STEMI患者在PCI术后发生MACE的AUC值为0.834,敏感度为0.833,特异度为0.739(P<0.001)。结论SIVGi和LVEF是MACE发生的独立预测指标。STEMI患者通过心脏磁共振检查测算SIVGi、LVEF,能够发现MACE高危人群,进而强化干预措施以改善预后。

Objective To investigate the predictive value of pericoronary adipose tissue(PCAT)thickness on the long-term prognosis of patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 195 patients who initially suffered from STEMI and underwent PCI at Nanjing Drum Tower Hospital followed by postoperative cardiac magnetic resonance examination from October 2019 to October 2021 were enrolled for retrospective analysis.Their general information,laboratory examination results,and cardiac magnetic resonance indexes were collected.All the patients were followed-up for 12 months after discharge.According to the occurrence of major adverse cardiovascular events(MACE),the patients were divided into two groups:a MACE group and a non-MACE group.Independent risk factors for MACE were determined by logistic regression analysis.ROC curves were plotted to analyze the predictive value of PCAT thickness and other indicators on the occurrence of MACE.Results Compared with the non-MACE group,the MACE group showed statistical differences in age,troponin T and B-type natriuretic peptide(BNP)levels,left ventricular ejection fraction(LVEF),left ventricular infarct area,microvascular occlusion(MVO),and adipose tissue thickness at superior interventricular groove(SIVGi)(P<0.05).According to multivariate logistic regression analysis,after adjustment for other risk factors,increased SIVGi(OR=2.742,95%CI 1.763-4.266,P<0.001)was still an independent risk factor for the occurrence of postoperative MACE in STEMI patients.Increased LVEF(OR=0.852,95%CI 0.775-0.935,P=0.001)was a protective factor.The AUC value of SIVGi combined with LVEF in predicting MACE in STEMI patients after PCI was 0.834,with a sensitivity of 0.833 and a specificity of 0.739(P<0.001).Conclusions SIVGi and LVEF are independent predictors of the occurrence of MACE.Measurement of SIVGi and LVEF by cardiac magnetic resonance in STEMI patients can facilitate intensive interventions for those at high risks of MACE,in order to improve prognosis.