临床误诊误治2023，Vol.36Issue(8)：40-45,6.DOI:10.3969/j.issn.1002-3429.2023.08.009
血运重建时机对急性心肌梗死患者血管再通率、心肌微循环、心功能及预后的影响
Effect of Revascularization Timing on Vascular Revascularization Rate,Myocardial Microcirculation,Cardiac Function and Prognosis in Patients with Acute Myocardial Infarction
摘要
Abstract
Objective To investigate the effects of revascularization timing on vascular revascularization rate,myo-cardial microcirculation,cardiac function and prognosis in patients with acute myocardial infarction(AMI).Methods A to-tal of 556 patients with AMI treated from January 2019 to June 2021 were selected and divided into early stage group(n = 278)and late stage group(n =278)according to the timing of revascularization.The early stage group underwent revascular-ization within 12 to 24 h after admission,and the late stage group underwent revascularization within 24 to 72 h after admis-sion.The rate of vascular revascularization,myocardial microcirculation indicators[starting time of contrast agent perfusion(AT),time to peak perfusion(APT),peak perfusion intensity(PI),curve rise slope(β),myocardial blood flow(MBF)],myocardial injury indicators[cardiac troponin I(cTnI),myocardial creatine kinase isoenzyme(CK-MB),N-terminal pro-brain natriuretic peptide(NT-proBNP)],vascular endothelial function indicators[serum endothelial cell spe-cific molecule-1(ESM-1),endothelin-1(ET-1),nitric oxide(NO)]before treatment,at 7 d and 3 months after treatment was compared between the two groups,and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventric-ular end-systolic diameter(LVDs),left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic volume(LVESV),and left ventricular end-diastolic volume(LVEDV)]were also analyzed before treatment and at 3 months after treatment.Results The rate of vascular revascularization in early stage group(96.40%,268/278)was higher than that in late stage group(90.29%,251/278),with significant difference(P＜0.01).AT,APT,PI,β,cTnI,CK-MB,NT-proBNP,ESM-1 and ET-1 in early stage group were lower than those in late stage group at 7 d and 3 months after treat-ment,while MBF and NO were higher than those in late stage group(P＜0.01).At 3 months after treatment,LVEF in early stage group was higher than that in late stage group,while LVDs,LVDd,LVESV and LVEDV were lower than those in late stage group(P＜0.01).The incidence of major adverse cardiovascular events(MACE)at6 months after treatment in the early stage group was lower than that in the late stage group(P＜0.05).Conclusion Revascularization within12 to24 h af-ter admission can significantly increase the rate of vascular revascularization in AMI patients,improve myocardial microcircula-tion,promote myocardial damage repair,correct vascular endothelial dysfunction,accelerate cardiac function recovery,and lower the risk of major adverse cardiovascular events.关键词
心肌梗死/血运重建/血管再通率/灌注达峰时间/心肌血流量/肌钙蛋白I/内皮素-1/预后Key words
Myocardial infarction/Revascularization/Vascular revascularization rat/Peak perfusion time/Myocar-dial blood flow/Troponin I/Endothelin-1/Prognosis分类
医药卫生引用本文复制引用
孙亚丽,刘心雨,张雪莲,宋欣仪,任淑红,张美玲..血运重建时机对急性心肌梗死患者血管再通率、心肌微循环、心功能及预后的影响[J].临床误诊误治,2023,36(8):40-45,6.基金项目
上海市卫生健康委科研项目(2021SH101) （2021SH101）
