摘要
目的:评估急性心肌梗死后冠状动脉微循环障碍(CMD)情况,并探讨其对急性心肌梗死患者住院期间主要不良心血管事件(MACE)的影响。方法:回顾性入选2015年11月至2021年7月北京大学人民医院因急性心肌梗死住院并在住院期间完成心肌声学造影(MCE)的患者162例。根据MCE结果分为冠状动脉微循环障碍组(CMD组)及微循环功能正常组(对照组)。分析两组患者的一般临床资料、急性心肌梗死、冠状动脉造影及血运重建情况以及超声心动图资料。评估两组患者住院期间MACE(包括急性左心衰竭、恶性心律失常、机械并发症、再发心肌梗死、脑卒中、死亡)情况。结果:162例急性心肌梗死患者中MCE证实存在CMD者100例(61.7%),与对照组相比,CMD组患者B型利钠肽(BNP)水平更高[268(91,671)ng/L vs.190(57,459)ng/L,P=0.006],Killip分级更差(P=0.017);左心室射血分数(LVEF)更低[55.0(44.3,63.0)%vs.60.5(54.0,66.3)%,P<0.001],左心室整体长轴应变(GLS)下降更为显著[-11.8(-9.2,-16.0)%vs.-13.9(-10.7,-17.0)%,P<0.001],节段性室壁运动异常(RWMA)发生率更高(93.0%vs.64.5%,P<0.001),室壁瘤发生率更高(18.0%vs.3.2%,P=0.005)。CMD组患者住院期间总MACE发生率为23.0%,校正混杂因素后显著高于对照组8.1%(OR=3.405,95%CI:1.221~9.500,P=0.019),住院期间MACE以急性左心衰竭最多见,CMD组患者急性左心衰竭发生率为17.0%,校正混杂因素后显著高于对照组4.8%(OR=5.205,95%CI:1.138~23.801,P=0.033)。结论:急性心肌梗死后发生CMD可增加患者住院期间MACE发生风险,尤其是急性左心衰竭风险。
Objectives:To evaluate the incidence of coronary microcirculation dysfunction(CMD)in patients with acute myocardial infarction(AMI)by myocardial contrast echocardiography(MCE)and to explore the impact of CMD on in-hospital major adverse cardiac events(MACE).Methods:162 AMI patients,who underwent MCE during hospitalization in Peking University People’s Hospital from November 2015 to July 2021,were enrolled in our study.According to myocardial perfusion,patients were divided into coronary microcirculation dysfunction group(CMD group)and non-CMD group.Clinical data related to AMI,coronary angiography,revascularization and results of MCE of the two groups were analyzed and compared.In-hospital MACE(including acute heart failure,sustained ventricular tachycardia/ventricular fibrillation,mechanical complications,stroke and death)of CMD patients were analyzed.Results:CMD occurred in 100 patients(61.7%).Compared with non-CMD group,CMD patients had higher level of B-natriuretic peptide(BNP)(268[91,671]ng/L vs.190[57,459]ng/L,P=0.006),poorer Killip grade(P=0.017),lower left ventricular ejection fraction(LVEF)(55.0[44.3,63.0]%vs.60.5[54.0,66.3]%,P<0.001),poor global longitudinal strain(GLS)(-11.8[-9.2,16.0]%vs.-13.9[-10.7,17.0]%,P<0.001),higher incidence of regional wall motion abnormality(RWMA)(93.0%vs.64.5%,P<0.001)and aneurysm(18.0%vs.3.2%,P=0.005).Total MACE happened in 23.0%of the CMD patients,which were significant higher than that in non-CMD group(8.1%),CMD remained as an independent risk factor of in-hospital MACE after adjusting the confounding factors(OR=3.405,95%CI:1.221-9.500,P=0.019).Acute heart failure was the major MACE in patients with AMI.The incident of acute heart failure was significantly higher in CMD group than in non-CMD group(17.0%vs.4.8%,P<0.05),CMD remained as an independent risk factor for acute heart failure after adjusting for the confounding factors(OR=5.205,95%CI:1.138-23.801,P=0.033).Conclusions:CMD after AMI increases the risk of in-hospital total MACE and acute heart failure.
作者
王岚
马玉良
王伟民
朱天刚
靳文英
赵红
曹成富
张前
王静
姜柏林
WANG Lan;MA Yuliang;WANG Weimin;ZHU Tiangang;JIN Wenying;ZHAO Hong;CAO Chengfu;ZHANG Qian;WANG Jing;JIANG Bailin(Department of Cardiology,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction,Center for Cardiovascular Translational Research,Peking University People’s Hospital,Beijing 100044,China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第12期1180-1185,共6页
Chinese Circulation Journal
基金
首都卫生发展科研专项项目(新)(首发2020-1-4031)。
关键词
急性心肌梗死
心肌声学造影
冠状动脉微循环障碍
主要不良心血管事件
acute myocardial infarction
myocardial contrast echocardiography
coronary microvascular dysfunction
major adverse cardiac events
