微循环阻力指数联合左室舒张末期压力指数预测急性心肌梗死患者预后的价值

The value of microcirculation resistance index combined with left ventricular end-diastolic pressure index in predicting the prognosis of patients with acute myocardial infarction

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者中联合测量微血管阻力指数(IMR)和左室舒张末期压力(LVEDP)对介入治疗(PCI)患者预后的价值。方法:选取2019年3月~2021年10月深圳市人民医院收治的STEMI患者73例,行急诊血运重建治疗。在直接PCI结束时进行IMR和LVEDP测量,根据结果分为低LVEDP/低IMR组(n=24),高LVEDP/低IMR组(n=14),低LVEDP/高IMR组(n=19),高LVEDP/高IMR组(n=16)。对术后住院期间及术后3个月时的心脏功能指标、随访起病之后1年时主要不良心脏事件(MACE)进行统计学分析。结果:入选STEMI患者均成功行再灌注治疗,术后TIMI血流均为Ⅲ级。四组比较,运重建治疗之后住院期间EF值比较差异无统计学意义(P>0.05)。血运重建治疗之后3个月,高LVEDP/高IMR组EF值低于其他组,差异有统计学意义(P<0.05),而其他三组之间EF值比较差异无统计学意义(P>0.05);术后及术后3个月,高LVEDP/高IMR组NT-proBNP值均高于其他组,差异有统计学意义(P<0.05),其他三组之间NT-proBNP值比较差异无统计学意义(P>0.05)。1年随访MACE发生率,高LVEDP/高IMR组的发生率显著升高,与其他三组比较,差异有统计学意义(P<0.05)。结论:IMR联合LVEDP可以明显提高对STEMI患者直接经皮冠状动脉介入治疗预后的预测价值。

Objective To investigate the value of combined measurement of microvascular resistance index(IMR)and left ventricular end-diastolic pressure(LVEDP)in patients with acute ST-segment elevation myocardial infarction(STEMI)in prognosis of patients after interventional therapy.Method 73 STEMI patients admitted to Shenzhen People′s Hospital from March 2019 to October 2021 weie selected for emergency revascularization.IMR and LVEDP were measured at the end of primary PCI,and they were divided into low LVEDP/low IMR group(n=24),high LVEDP/low IMR group(n=14),low LVEDP/high IMR group(n=19),high LVEDP/high IMR group(n=16)according to the results.Cardiac function indicators during postoperative hospitalization and 3 months after surgery,and MACE events at 1 year after the onset of follow-up were statistically analyzed.Results All patients were successfully treated with reperfusion,and the postoperative TIMI blood flow was all gradeⅢ.Comparing the four groups,there was no difference in EF values during hospitalization after reconstruction therapy(P>0.05).At 3 months after revascularization,the EF value of the high LVEDP/high IMR group was lower than that of the other groups(P<0.05),while there was no statistical difference in the EF value between the other three groups(P>0.05).The NT-proBNP values in the high LVEDP/high IMR group were higher than those in the other groups(P<0.05),and there was no statistical difference in the NT-proBNP values among the other three groups(P>0.05).In the 1-year follow-up,the incidence of MACE events was significantly higher in the high LVEDP/high IMR group,which was significantly different from the other three groups(P<0.05).Conclusion IMR combined with LVEDP can significantly improve the predictive value of direct percutaneous coronary intervention in STEMI patients.