STEMI患者直接PCI术后发生心肌内出血的危险因素及其预测价值分析

Risk factors and predictive value of intramyocardial hemorrhage after pPCI in patients with STEMI

目的探讨ST段抬高型心肌梗死(STEMI)患者接受直接经皮冠状动脉介入治疗(PPCI)术后发生心肌内出血(IMH)的危险因素及IMH对左室重构的影响。方法前瞻性纳入2019年10月至2022年3月间于北京友谊医院心血管中心行直接PCI术的患者159例,依据术后1周内的心脏核磁共振(CMR)检查将患者分为两组:IMH组(n=66)和非IMH组(n=93),随访并于6月后复查CMR,依据患者CMR结果评估是否发生左心室恶化重构。比较IMH组与非IMH组患者的基线资料、围术期以及左室重构等相关数据,采用多因素Logistic回归分析发生IMH的危险因素,通过受试者工作特征(ROC)曲线计算对IMH的预测价值。结果超敏C反应蛋白(hs-CRP)、肌钙蛋白T(cTnT)峰值水平IMH组高于非IMH组,差异有统计学意义(P<0.05),ROC分析显示对于STEMI患者发生IMH的预测价值,hs-CRP及cTnT峰值:ROC曲线下面积分别为0.66、0.76(P<0.05)。结论hs-CRP及cTnT峰值是STEMI患者发生IMH的独立危险因素,对IMH的发生具有一定预测价值。

Objective To explore the risk factors for intramyocardial hemorrhage(IMH)in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(pPCI)and the impact of IMH on left ventricular remodeling.Methods A total of 159 patients who underwent pPCI at the Cardiovascular Center of Beijing Friendship Hospital between October 2019 and March 2022 were prospectively included.The patients were divided into two groups based on cardiac magnetic resonance(CMR)examination within 1 week after surgery:IMH group(n=66)and non-IMH group(n=93).All patients were followed up and reexamined CMR after 6 months.To compare the baseline data,left ventricular remodeling and other related data between the IMH group and the non-IMH group,multi-factor logistic regression was used to identify the risk factors for IMH.Results The the peak level of cTnT and the level of hs-CRP and in the IMH group were higher than those in the non-IMH group,and the difference was statistically significant(P<0.05).The ROC showed the predictive value of IMH in patients with STEMI.Hs-CRP and cTnT peak:ROC were 0.66 and 0.76 respectively(P<0.05).Conclusion Hs-CRP and cTnT peak are independent risk factors for IMH in STEMI patients and have certain predictive value for the occurrence of IMH.