付斐,杨丽霞,樊君,陈长征,石燕昆

• 1:中国人民解放军联勤保障部队第九二〇医院心血管内科

摘要(Abstract)：

目的 探讨ST段抬高型心肌梗死（STEMI）各救治时间节点与直接经皮冠状动脉介入治疗（PCI）术后发生冠状动脉微循环障碍（CMD）的关系及其预后，为早期识别高危患者、进一步优化救治体系、缩短救治时间、改善预后提供依据。方法 本研究选取2023年3月至2023年9月就诊于中国人民解放军联勤保障部队第九二〇医院直接接受PCI的STEMI患者150例，基于冠状动脉造影的微循环阻力指数（caIMR）≥40 U为PCI术后CMD组（89例），caIMR<40 U为无CMD组（61例）。收集两组患者的临床资料、各项检查指标及影像资料，并随访患者直接PCI术后6个月内主要不良心血管事件（MACE）的发生情况。两变量间的相关性采用Spearman进行分析；多因素Logistic回归分析各救治时间点与直接PCI术后发生CMD的关系；采用受试者工作特征（ROC）曲线分析直接PCI术后发生CMD的预测指标；用Kaplan-Meier法绘制两组间的生存曲线。结果 CMD组中发病至球囊扩张（S-to-B）、发病至首次医疗接触（S-to-FMC）、首次医疗接触至球囊扩张（FMC-to-B）、发病至入门（S-to-D）、首次医疗接触至入门（FMC-to-D）时间均明显高于无CMD组（均P<0.05）。相关性分析显示S-to-D、S-to-FMC、FMC-to-B、FMC-to-D时间均与S-to-B时间呈正相关（r=0.996,P<0.001;r=0.937,P<0.001;r=0.431,P<0.001;r=0.441,P<0.001）；多因素Logist ic回归分析表明，S-to-D时间（OR2.165,95%CI 1.655～2.830,P<0.001）是CMD的独立危险因素；且S-to-D时间对直接PCI术后发生CMD有较高的预测价值，ROC曲线下面积为0.898(95%CI 0.850～0.946,P<0.001)，最佳截断值为231 min，敏感度82.0%，特异度88.5%;Kaplan-Meier曲线分析显示，CMD组发生MACE结局的累积生存率明显低于无CMD组（Log-rank P=0.009）。结论 缩短S-t o-D时间可减少P C I术后C M D的发生，从而降低M A C E的发生率，有助于改善预后。

关键词(KeyWords)： 胸痛中心体系;急性ST段抬高型心肌梗死;救治时间;再灌注微循环障碍

Abstract:

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基金项目(Foundation):

作者(Author): 付斐,杨丽霞,樊君,陈长征,石燕昆

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