2022 年第 8 期 第 17 卷

急性ST段抬高型心肌梗死患者冠状动脉微血管疾病的风险评估

Risk assessment of coronary microvascular disease in patients with acute ST-segment elevation myocardial infarction

作者：刘雨薇王衍曾玉杰

英文作者：Liu Yuwei Wang Yan Zeng Yujie

单位：首都医科大学附属北京安贞医院心内科，北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性ST段抬高型心肌梗死；冠状动脉微血管疾病；微血管阻塞；心肌内出血

英文关键词：AcuteST-segmentelevationmyocardialinfarction；Coronarymicrovasculardisease；Microvascularobstruction；Intramyocardialhemorrhage

• 摘要：

• 目的 探讨急性ST段抬高型心肌梗死(STEMI)患者发生冠状动脉微血管疾病(CMVD)的危险因素。方法 入选2019年9月至2021年3月首都医科大学附属北京安贞医院急诊科因急性STEMI行急诊经皮冠状动脉介入(PCI)治疗，且发病3～7 d内接受心脏磁共振成像(CMR)检查的239例患者。通过CMR识别微血管阻塞(MVO)和心肌内出血(IMH)以诊断CMVD。根据患者有无MVO分为MVO组（123例）和无MVO组（116例）；根据患者有无IMH分为IMH组（52例）和无IMH组（187例）。应用Logistic回归方法分析急性STEMI患者急诊PCI术后发生MVO或IMH的独立影响因素。结果 Logistic回归分析结果显示，男性(比值比=2.46，95%置信区间：1.00～6.02，P=0.049)、IMH(比值比=6.86，95%置信区间：2.77～16.76，P＜0.001)、术前心肌梗死溶栓试验（TIMI）血流分级0级(比值比=3.63，95%置信区间：1.40～9.45，P=0.008)是急性STEMI患者PCI术后发生MVO的独立危险因素，造影剂类型为碘美普尔(比值比=0.16，95%置信区间：0.03～0.91，P=0.038)是急性STEMI患者PCI术后发生MVO的保护性因素。MVO、罪犯血管为前降支是急性STEMI患者PCI术后发生IMH的独立危险因素（均P＜0.05）。结论 男性、IMH、术前TIMI血流分级0级是行急诊PCI的急性STEMI患者发生MVO的危险因素，而MVO、罪犯血管为前降支是发生IMH的危险因素。

• Objective To investigate the risk factors of coronary microvascular disease (CMVD) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Totally 239 patients who underwent emergency percutaneous coronary intervention (PCI) due to STEMI and underwent cardiac magnetic resonance imaging (CMR) within 3-7 d after onset were selected in Department of Emergency, Beijing Anzhen Hospital, Capital Medical University from September 2019 to March 2021. Microvascular (MVO) and intramyocardial hemorrhage (IMH) were identified to diagnose CMVD through CMR. Patients were divided into MVO group (123 cases) and non MVO group (116 cases) according to the presence or absence of MVO; patients were divided into IMH group (52 cases) and non IMH group (187 cases) according to the presence or absence of IMH. Logistic regression model was used to analyze the independent influencing factors of MVO or IMH after emergency PCI in STEMI patients. Results Logistic regression analysis showed that male ［odds ratio(OR)=2.46, 95% confidence interval(CI):1.00-6.02, P=0.049］, IMH (OR=6.86, 95%CI:2.77-16.76, P＜0.001) and preoperative thrombolysis test in myocardial infarction (TIMI)  grading 0 (OR=3.63, 95%CI:1.40-9.45, P=0.008) were independent risk factors for MVO after PCI in STEMI patients, while iomeprol contrast agent (OR=0.16, 95%CI:0.03-0.91, P=0.038) was a protective factor; MVO and culprit vessel as anterior descending were independent risk factors for IMH after PCI in STEMI patients (both P＜0.05). Conclusions  For STEMI patients undergoing emergency PCI, male, IMH, and preoperative TIMI grading 0 are independent risk factors of the MVO occurrence. MVO and culprit vessel as anterior descending are independent risk factors of the IMH occurrence.