摘要
目的 探讨使用微循环阻力指数(IMR)早期预测急性冠状动脉综合征(ACS)和稳定性心绞痛(SAP)患者行经皮冠状动脉介入治疗(PCI)发生围术期心肌损伤(PMI)的价值.方法 前瞻性研究.纳入2014年5月至2017年12月在南京医科大学附属南京医院连续入选的164例冠状动脉单支病变患者,根据患者临床表现分为SAP组(n=81)和ACS组(n=83).使用压力导丝采用热稀释法检测IMR,同时比较两组患者的临床基线资料、冠状动脉造影结果、PCI术中情况、PCI术后IMR和△IMR(△IMR=术后IMR-术前IMR)以及PCI手术前后的心肌生物标志物水平及其差值.采用多因素logistic回归分析IMR及△IMR与围手术期心肌损伤的关系,并用受试者工作特征(ROC)曲线评价其预测能力.结果 ACS组的总胆固醇和低密度脂蛋白胆固醇水平明显高于SAP组(P<0.05),两组其他临床基线资料比较差异均无统计学意义(P>0.05).两组患者PCI术前目标血管的定量冠状动脉造影(QCA)结果及PCI术中资料比较,差异均无统计学意义(P均>0.05).ACS组患者冠状动脉内注射室温生理盐水的平均传导时间(Tmn)、PCI术后IMR和△IMR均高于SAP组(P<0.05).ACS组磷酸肌酸激酶-MB差值(△CK-MB)(△CK-MB=术后CK-MB-术前CK-MB)和心脏肌钙蛋白I差值(△cTnI)(△cTnI=术后cTnI-术前cTnI)也均显著高于SAP组(P<0.05).多因素logistic回归分析显示冠心病类型(OR=1.301,95%CI 1.083~1.562)、年龄(OR=1.007,95%CI 1.000~1.013)、△IMR (OR=1.009,95%CI1.000~1.017)和PCI术后IMR(OR=1.008,95%CI1.001~1.014)是PMI的独立预测因子(P<0.05);△IMR预测发生PMI的ROC曲线下面积为0.763(P<0.05),△IMR预测发生PMI的最佳界定值为5.485,敏感度为70.0%,特异度为77.4%.△IMR与△cTnI呈正相关(r=0.592,P<0.05).结论 △IMR可早期预测冠心病患者PMI,且与SAP患者相比,ACS患者更易发生PMI.
Objective To explore the value of index of microcirculatory resistance (IMR) for early prediction of periprocedural myocardial injury (PMI) in patients with stable angina pectoris (SAP) and acute coronary syndrome (ACS) after PCI.Methods It was a prospective study.One hundred and sixty-four patients who had single coronary lesion were consecutively enrolled from May 2014 to December 2017 at Nanjing Hospital affiliated to Nanjing Medical University.According to clinical manifestation,patients were divided into SAP group (n=81) and ACS group (n=83).IMR was determined by thermal dilution with pressure guide wire.Basic clinical characteristics,coronary angiographic results,PCI procedural details,IMR after PCI,△IMR (IMR=post-PCI-IMR pre-PCI),levels of myocardial biomarkers before and after PCI were compared between the two groups.Multivariate logistic regression was used to analyze the relation of PMI with IMR and △IMR,and the predictive ability was evaluated by receiver operating characteristic (ROC).Results The levels of total cholesterol and low density lipoprotein cholesterol were significantly higher in ACS group than in SAP group (P<0.05),other clinical data at baseline were similar between the two groups (P>0.05).Quantitative coronary angiography (QCA) results and PCI related data were also similar between the two groups before PCI (P>0.05).Values of mean transit time (Tmn) of intracoronary injection with room temperature saline,post-PCI IMR and △IMR were significantly higher in ACS group than in SAP group after PCI (P<0.05).Plasma creatine kinase isoenzyme-MB difference (△CK-MB) (△CK-MB=CK-MB post-PCI-CK-MB pre-PCI) and cardiac troponin-I (cTnI) difference (△cTnI=cTnI post-PCI-cTnI pre-PCI)were significantly larger in ACS group than in SAP group (P<0.05).Multivariate logistic regression analysis showed that coronary artery disease (CHD) type (SAP and ACS) (OR=1.301,95%CI 1.083-1.562),age (OR=1.007,95%CI 1.000-1.013),△IMR (OR=1.009,95%CI 1.000-1.017) and post-PCI IMR (OR=1.008,95%CI 1.001-1.014) w
作者
尤威
杨志健
叶飞
You Wei;Yang Zhijian;Ye Fei(Department of Cardiology,First Affiliated Hospital of Nanjing Medical University,210029;Department of Cardiology,Nanjing First Hospital,Nanjing Hospital Affiliated Nanjing Medical University,Nanjing 210006,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2019年第11期894-900,共7页
Chinese Journal of Cardiology
关键词
冠状动脉疾病
微循环
微循环阻力指数
心肌损伤
Coronary artery disease
Microcirculation
Index of microcirculatory resistance
Myocardial injury
