2019 年第 10 期 第 14 卷

心肌梗死溶栓试验危险评分与ST段抬高型心肌梗死患者直接冠状动脉介入术后心肌组织灌注的关系分析

Relationship between thrombolysis in myocardial infarction risk score and myocardial perfusion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

作者：高玉龙龚晓刚陶英张京梅

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科（高玉龙、陶英、张京梅）；100045北京核工业医院内科（龚晓刚）

英文单位：

关键词：ST段抬高型心肌梗死；直接冠状动脉介入；心肌梗死溶栓试验危险评分

英文关键词：

• 摘要：

• 【摘要】目的    分析心肌梗死溶栓试验（TIMI）危险评分与ST段抬高型心肌梗死（STEMI）患者直接冠状动脉介入（PPCI）术后心肌组织灌注的关系。方法    连续收集2018年1—12月在首都医科大学附属北京安贞医院因STEMI入院并行PPCI的882例患者的临床资料行回顾性分析。根据TIMI危险评分将患者分为低危组（0～3分，380例）、中危组（4～6分，424例）和高危组（≥7分，78例）。比较3组基线资料，冠状动脉造影、PPCI情况，心肌组织灌注水平，分析心肌组织灌注的影响因素。结果    高危组年龄、男性比例、糖尿病比例、高血压比例明显高于中危组与低危组，中危组明显高于低危组，差异均有统计学意义（均P<0.05）。高危组前壁心肌梗死比例、心率、空腹血糖明显高于中危组与低危组，而收缩压明显低于中危组与低危组，差异均有统计学意义（均P<0.05）。高危组多支血管病变比例明显高于中危组与低危组［63.2%(49/78)比34.4%(146/424)、14.3%(54/380)］，中危组明显高于低危组，差异均有统计学意义（均P<0.05）。高危组梗死动脉开通时间明显长于中危组与低危组［（79±27）min比（63±18）、（58±14）min］，差异有统计学意义（P<0.05）。TIMI血流分级法、TIMI心肌灌注分级和心肌blush分级法，高危组达到3级的比例明显低于中危组与低危组，差异均有统计学意义（均P<0.05）。Logistic回归分析结果显示，TIMI危险评分是STEMI患者PPCI术后影响心肌组织灌注的因素（比值比=4.987，95%置信区间：1.243～7.516，P=0.016）。结论    TIMI危险评分属高危的STEMI患者经PPCI治疗后，心肌组织水平血流灌注差，从而影响预后。应及早评估这些高危患者，尽早开通梗死相关动脉，改善心肌灌注，改善预后。

• 【Abstract】Objective    To analyze the relationship between thrombolysis in myocardial infarction(TIMI) risk score and myocardial perfusion in patients with ST-segment elevation myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(PPCI). Methods    Clinical data of 882 STEMI patients undergoing PPCI from January to December 2018 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. The patients were divided into 3 groups according to TIMI risk score: low risk group(TIMI risk score 0-3, 380 cases), moderate risk group(TIMI risk score 4-6, 424 cases) and high risk group(TIMI risk score≥7, 78 cases). Baseline data, coronary angiography, PPCI procedure and myocardial perfusion were recorded and the influencing factors of myocardial perfusion were analyzed. Results    Age, rates of male, diabetes and hypertension increased among low, moderate and high risk groups(all P<0.05). Rate of anterior myocardial infarction, heart rate and fasting blood sugar content in high risk group were higher and systolic blood pressure was lower than those in low and moderate risk groups(all P<0.05). Higher rate of multi-vessel disease was observed with higher TIMI risk score［63.2%(49/78) for high risk group vs 34.4%(146/424) for moderate risk group vs 14.3%(54/380) for low risk group］（all P<0.05）. Infarction to reperfusion time was significantly delayed in high risk group compared to moderate and low risk groups［（79±27）min vs （63±18）,（58±14）min］(both P<0.05). Rates of myocardial perfusion grade 3 measured by TIMI blood flow, TIMI myocardial perfusion and myocardial blush grade significantly descended in high risk group compared to those in moderate and low risk groups（all P<0.05）. Logistic regression analysis showed that TIMI risk score was an independent predictor of myocardial perfusion following PPCI(odds ratio=4.987, 95% confidence interval: 1.243-7.516, P=0.016). Conclusions    STEMI patients with high TIMI risk score have poor myocardial perfusion after PPCI. Early identification of high risk patients and timely restoring of smooth blood flow can improve myocardial perfusion and the progress.