张慧,王黎,上官海娟,汪敏,鄢华

• 1:武汉科技大学附属武汉亚洲心脏病医院心内科
• 2:武汉科技大学医学部医学院

摘要(Abstract)：

目的 评估急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后冠状动脉微血管阻塞（MVO）的情况，并探讨其对患者预后的价值。方法 入选2021年5月至2024年6月武汉亚洲心脏病医院因急性STEMI住院，住院期间行急诊PCI，并于术后中位7(5,8)d完成心脏磁共振成像（CMR）的患者97例。根据CMR结果分为MVO组（58例）和无MVO组（39例）。采用Cox回归分析PCI术后不良事件发生的预测因子。对患者中位随访11.5(8.5,24.5)个月，观察患者的主要不良心血管事件（MACE，包括心力衰竭再入院、再发心肌梗死、靶血管再狭窄、靶血管血运重建及心源性死亡的复合结局）及次要终点事件（左心室重构、非心源性死亡）发生情况。结果 97例急性STEMI患者中CMR证实存在MVO者58例（59.79%）。多因素Cox回归分析显示，MVO(HR 7.024,95%CI 1.408～35.027,P=0.017)及左心室非活性心肌占左心室总质量比例（HR 1.066,95%CI 1.014～1.121,P=0.012）是STEMI患者PCI术后发生不良事件的独立预测因子。中位随访时间11.5(8.5,24.5)个月，无MVO组和MVO组MACE发生率比较，差异无统计学意义（P=0.347），但MVO组患者次要终点发生率更高（32.76%比2.56%,P<0.001），左心室重构发生率更高（29.31%比2.56%,P<0.001）。Kaplan-Meier生存分析显示，无MVO组预后显著优于MVO组（Log-rank P<0.001）。结论 急性STEMI患者PCI术后的MVO对临床预后具有很好的预测作用。

关键词(KeyWords)： 急性ST段抬高型心肌梗死;冠状动脉微循环障碍;微血管阻塞;心脏磁共振成像;主要不良心血管事件

Abstract:

Keywords:

基金项目(Foundation): 武汉市心血管影像临床医学研究中心2023年度开放基金立项项目（CMRC202310）;; 2022年度知识创新专项基础研究项目（2022020801010576）;; 2023年武汉市医学科学研究项目-揭榜挂帅项目（WX23J02）

作者(Author): 张慧,王黎,上官海娟,汪敏,鄢华

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