冠状动脉血管内超声参数对急性心肌梗死患者PCI治疗预后的影响

Significance of intracavitary ultrasound parameters plaque load and eccentricity index in percutaneous coronary interventional therapy

目的 探讨冠状动脉血管内超声参数对急性心肌梗死患者PCI治疗预后的影响。方法 选择2021年2月—2022年10月医院收治的103例接收PCI治疗的急性心肌梗死患者,随访1年,根据患者是否发生主要心脏不良事件(包括心源性休克、复发心绞痛、严重心率失常、复发急性心肌梗死、心力衰竭)分为预后良好组与预后不良组。将组间资料进行对比,利用Logistic回归分析、受试者工作特征(ROC)曲线来评估患者PCI治疗预后。结果 随访1年,103例患者中42例(40.78%)发生主要心脏不良事件,其中心源性休克1例、复发心绞痛13例、心力衰竭11例、复发急性心肌梗死12例、严重心律失常5例,命名为预后不良组,其余61例(59.22%)未发生主要心脏不良事件命名为预后良好组。预后不良组斑块负荷、斑块面积、偏心指数均高于预后不良组(P<0.05)。多因素Logistic回归分析结果显示,斑块负荷、偏心指数是急性心肌梗死患者发生主要心脏不良事件的影响因素(P<0.05)。ROC曲线结果显示,斑块负荷、偏心指数及二者联合预测急性心肌梗死患者发生主要心脏不良事件的灵敏度分别为85.65%、81.91%、83.33%,特异度分别为82.24%、87.85%、96.26%,曲线下面积(AUC)分别为0.783、0.845、0.935(P<0.05),且二者联合的AUC值更高(P<0.05)。结论 冠状动脉血管内超声参数斑块负荷、偏心指数在评估急性心肌梗死患者PCI治疗预后中具有重要价值,且二者联合具有更高的预测价值。

ObjectiveTo investigate the significance of intracavitary ultrasound parameters plaque load and eccentricity index in percutaneous coronary interventional(PCI) therapy.MethodsA total of 103 patients with acute myocardial infarction treated by PCI from February 2021 to October 2022 were selected and followed up for 1 year.According to whether the patient has experienced major adverse cardiac events(including cardiogenic shock,recurrent angina,severe arrhythmia,recurrent acute myocardial infarction,etc.),they are divided into a good prognosis group and a poor prognosis group.Compare inter group data and evaluate using Logistic regression analysis and receiver operating characteristic(ROC) curves.ResultsDuring 1-year follow-up,42(40.78%) of the 103 patients had major adverse cardiac events,including 1 case of central shock,13 cases of recurrent angina pectoris,11 cases of heart failure,12 cases of recurrent acute myocardial infarction,and 5 cases of severe arrhythmia,which were recorded as the poor prognosis group.The remaining 61 patients(59.22%) with no major adverse cardiac events were classified as the good prognosis group.There were statistically significant differences in plaque load,plaque area and eccentricity index between the two groups:the plaque load,plaque area and eccentricity index in the poor prognosis group were higher than those in the poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that plaque load and eccentricity index were the influencing factors for major cardiac adverse events in patients with acute myocardial infarction(P<0.05).ROC curve results showed that the sensitivity of plaque load,eccentricity index and their combination to predict the occurrence of major cardiac adverse events in patients with acute myocardial infarction were83.33%,83.33% and 83.33%,respectively,and the specificity was 82.24%,87.85% and 96.26%,respectively.The AUC were 0.783,0.845 and 0.935(P<0.05),respectively,and the AUC of the combination were higher(P<0.05).ConclusionIntracavitary ultrasound parameters of plaque load and eccentricity index have important value in evaluating the prognosis of patients with acute myocardial infarction after PCI,and the combination of the two has higher predictive value.