朱清一,胡信群,周胜华

• 1:中南大学湘雅二医院心内科

摘要(Abstract)：

<正>冠状动脉微循环是指由微动脉、毛细血管和微静脉构成的微循环系统。对于ST段抬高心肌梗死(STEMI)患者,尽管经皮冠状动脉介入治疗(PCI)使其心外膜动脉血流正常,仍然有1/3的患者没有达到心肌微循环灌注。微循环功能障碍被认为是PCI术后无复流现象的始作俑者,可以独立预测远期死亡的发生[1]。近年来提出的微循环阻力指数(IMR)是目前评价微循环功能相对简单的定量指标。通过与血流储备分数(FFR)同样的设备可以测定IMR。以下就IMR在PCI中的临床应用作一综述。

关键词(KeyWords)： 微循环阻力指数;经皮冠状动脉介入治疗;ST段抬高心肌梗死

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 朱清一,胡信群,周胜华

参考文献(References)：

• [1]Ndrepepa G,Tiroch K,Fusaro M,et al.5-year prognostic value of no-refl ow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction.J Am Coll Cardiol,2010,55:2383-2389.
• [2]Lim HS,Yoon MH,Tahk SJ,et al.Usefulness of the index of microcirculatory resistance for invasively assessing myocardial viability immediately after primary angioplasty for anterior myocardial infarction.Eur Heart J,2009,30:2854-2860.
• [3]Ng MK,Yong AS,Ho M,et al.The index of microcirculatory resistance predicts myocardial infarction related to percutaneous coronary intervention.Circ Cardiovasc Interv,2012,5:515-522.
• [4]Yamada R,Okura H,Kume T,et al.Target lesion thin-cap fibroatheroma defi ned by virtual histology intravascular ultrasound affects microvascular injury during percutaneous coronary intervention in patients with angina pectoris.Circ J,2010,74:1658-1662.
• [5]Seo MK,Koo BK,Kim JH,et al.Comparison of hyperemic efficacy between central and peripheral venous adenosine infusion for fractional flow reserve measurement.Circ Cardiovasc Interv,2012,5:401-405.
• [6]Yong AS,Ho M,Shah MG,et al.Coronary microcirculatory resistance is independent of epicardial stenosis.Circ Cardiovasc Interv,2012,5:103-108.
• [7]Yong AS,Layland J,Fearon WF,et al.Calculation of the Index of Microcirculatory Resistance Without Coronary Wedge Pressure Measurement in the Presence of Epicardial Stenosis.JACC:Cardiovasc Interv,2013,6:53-58.
• [8]Layland J,MacIsaac AI,Burns AT,et al.When collateral supply is accounted for epicardial stenosis does not increase microvascular resistance.Circ Cardiovasc Interv,2012,5:97-102.
• [9]Fearon WF,Shah M,Ng M,et al.Predictive value of the index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction.J Am Coll Cardiol,2008,51:560–565.
• [10]McGeoch R,Watkins S,Berry C,et al.The index of microcirculatory resistance measured acutely predicts the extent and severity of myocardial infarction in patients with ST-segment elevation myocardial infarction.JACC:Cardiovasc Interv,2010,3:715-722.
• [11]Kim JH,Park JH,Choo K,et al.Pressure-wire based assessment of microvascular resistance using calibrated upstream balloon obstruction:a predictor of myocardial viability.Catheter Cardiovasc Interv,2012,80:581-589.
• [12]Oh JH,Kim C,Ahn J,et al.The Relationship between Microcirculatory Resistance and Fractional Flow Reserve in Patients with Acute Myocardial Infarction.Korean Circ J,2013,43:534-540.
• [13]Yoo SH,Yoo TK,Lim HS,et al.Index of microcirculatory resistance as predictor for microvascular functional recovery in patients with anterior myocardial infarction.J Korean Med Sci,2012,27:1044-1050.
• [14]Bonello L,Ait Mokhtar O,Lemesle G,et al.Incidence and predictors of microvascular dysfunction assessed by the index of microcirculatory resistance following primary PCI for ST-elevation myocardial infarction.Int J Cardiol,2011,146:465-467.
• [15]Erkol A,Pala S,Kιrma C,et al.Relation of circulating osteoprotegerin levels on admission to microvascular obstruction after primary percutaneous coronary intervention.Am J Cardiol,2011,107:857-562.
• [16]Layland J,Whitbourn R,Burns A,et al.The index of microvascular resistance identifies patients with periprocedural myocardial infarction in elective percutaneous coronary intervention.Heart(British Cardiac Society),2012,98:1492-1497.
• [17]Ito N,Nanto S,Doi Y,et al.High index of microcirculatory resistance level after successful primary percutaneous coronary intervention can be improved by intracoronary administration of nicorandil.Circ J,2010,74:909-915.
• [18]Fujii K,Kawasaki D,Oka K,et al.The impact of pravastatin pretreatment on periprocedural microcirculatory damage in patients undergoing percutaneous coronary intervention.JACC:Cardiovasc Interv,2011,4:513-520.
• [19]Mangiacapra F,Peace A,Di Serafino L,et al.Intracoronary Enalaprilat to Reduce Microvascular Damage During Percutaneous Coronary Intervention(ProMicro)study.J Am Coll Cardiol,2012,61:615-621.
• [20]Sezer M,Cimen A,Aslanger E,et al.Effect of intracoronary streptokinase administered immediately after primary percutaneous coronary intervention on long-term left ventricular infarct size,volumes,and function.J Am Coll Cardiol,2009,54:1065-1071.
• [21]Ito N,Nanto S,Doi Y,et al.Distal protection during primary coronary intervention can preserve the index of microcirculatory resistance in patients with acute anterior ST-segment elevation myocardial infarction.Circ J,2011,75:94-98.
• [22]Layland J,Judkins C,Palmer S,et al.The resting status of the coronary microcirculation is a predictor of microcirculatory function following elective PCI for stable angina.Int J Cardiol,2013,169:121-125.
• [23]Layland J,Carrick D,McEntegart M,et al.Vasodilatory capacity of the coronary microcirculation is preserved in selected patients with non-ST-segment-elevation myocardial infarction.Circ Cardiovasc Interv,2013,6:231-236.