Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain.
Int J Cardiol. 2013 Jun 5;166(1):77-84. doi: 10.1016/j.ijcard.2011.09.083. Epub 2011 Oct 20.
Early stratification of patients according to the risk for developing microvascular obstruction (MVO) after ST-segment elevation myocardial infarction (STEMI) is desirable. We aimed to identify predictors of cardiovascular magnetic resonance (CMR)-derived MVO from clinical+ECG, laboratory and angiographic parameters available on admission.
Characteristics available on admission were documented in 97 STEMI patients referred for primary angioplasty. MVO was determined using contrast-enhanced CMR.
MVO was present in 44 patients (45%). The C-statistic for predicting MVO was: clinical+ECG (.832), laboratory (.743), and angiographic parameters (.669). Adding laboratory to clinical+ECG information did not improve the C-statistic (.873 vs. .832, p=.2). Further addition of angiographic data (.904) improved the C-statistic of clinical+ECG (p=.04) but not of clinical+ECG and laboratory (p=.2). Independent predictors of MVO using clinical and ECG parameters were: Killip class >1 (OR 15.97 95%CI [1.37-186.76], p=.03), diabetes (OR 6.15 95%CI [1.49-25.39], p=.01), age <55years (OR 4.70 95%CI [1.56-14.17], p=.006), sum of ST-segment elevation >10mm (OR 4.5 95%CI [1.58-12.69], p=.005) and delayed presentation >3h (OR 3.80 95%CI [1.19-12.1], p=.02). A score was constructed assigning Killip class >1 2 points and the remaining indexes 1 point. The incidence of MVO increased with the score: 0 point: 8.7%; 1 point: 28.1%; 2 points: 71.4%; and 3+ points: 93% (p<.0001).
MVO can be predicted using parameters already available on patient admission. We developed a clinical-ECG score allowing for early and reliable classification of STEMI patients according to the risk of MVO.
根据 ST 段抬高型心肌梗死（STEMI）后发生微血管阻塞（MVO）的风险对患者进行早期分层是可取的。我们旨在确定可从入院时的临床+心电图、实验室和血管造影参数中识别出心血管磁共振（CMR）衍生的 MVO 的预测因子。
在 97 例接受直接经皮冠状动脉介入治疗的 STEMI 患者中记录了入院时可获得的特征。使用对比增强 CMR 确定 MVO。
44 例患者（45%）存在 MVO。预测 MVO 的 C 统计量为：临床+心电图（.832）、实验室（.743）和血管造影参数（.669）。将实验室信息添加到临床+心电图信息中并没有提高 C 统计量（.873 比.832，p=.2）。进一步增加血管造影数据（.904）提高了临床+心电图的 C 统计量（p=.04），但没有提高临床+心电图和实验室的 C 统计量（p=.2）。使用临床和心电图参数的 MVO 的独立预测因子为：Killip 分级>1（OR 15.97 95%CI [1.37-186.76]，p=.03）、糖尿病（OR 6.15 95%CI [1.49-25.39]，p=.01）、年龄<55 岁（OR 4.70 95%CI [1.56-14.17]，p=.006）、ST 段抬高总和>10mm（OR 4.5 95%CI [1.58-12.69]，p=.005）和延迟就诊>3 小时（OR 3.80 95%CI [1.19-12.1]，p=.02）。构建了一个评分系统，将 Killip 分级>1 赋值 2 分，其余指标赋值 1 分。MVO 的发生率随评分增加而增加：0 分：8.7%；1 分：28.1%；2 分：71.4%；3 分及以上：93%（p<.0001）。
可以使用患者入院时已有的参数预测 MVO。我们开发了一种临床-心电图评分系统，可根据 MVO 的风险对 STEMI 患者进行早期和可靠的分类。
