外周动脉张力测定术揭示经皮冠状动脉介入治疗围术期心肌损伤患者内皮功能受损。

Peripheral Artery Tonometry Reveals Impaired Endothelial Function before Percutaneous Coronary Intervention in Patients with Periprocedural Myocardial Injury.

机构信息

Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China.

Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Geriatric Medical Center, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China.

出版信息

J Interv Cardiol. 2021 Jul 15;2021:5598120. doi: 10.1155/2021/5598120. eCollection 2021.

DOI:10.1155/2021/5598120

PMID:34354549

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8298173/

Abstract

BACKGROUND

Periprocedural myocardial injury (PMI) is a most common complication of percutaneous coronary intervention (PCI). Microembolization and inflammation underlying PMI could lead to coronary microvascular dysfunction (CMD) and vice versa. Reactive hyperemia index (RHI) assessed by peripheral artery tonometry (PAT) has been considered as a noninvasive method to assess endothelial function and CMD, which could be useful to predict PMI.

METHODS

268 patients suspected with stable coronary artery disease (CAD) and scheduled for elective coronary angiography were enrolled. RHI was measured by using the Endo-PAT2000™ device before angiography. The association among RHI, PMI, and cardiovascular events was further assessed.

RESULTS

In this cohort, 189 patients (70.5%) were diagnosed with CAD and 119 patients (44.4%) underwent drug-eluting stent (DES) implantation. Compared with patients without CAD, CAD patients had lower RHI (1.88 ± 0.55 vs. 2.02 ± 0.58, < 0.05). Patients with PMI had a lower RHI before angiography (1.75 ± 0.37 vs. 1.95 ± 0.50, < 0.05). Receiver operating characteristic curve analysis of RHI revealed an area under the curve (AUC) of 0.61, with a sensitivity of 62.7% and specificity of 50.0% to predict PMI. Moreover, we found that CAD patients with RHI ≤ 1.81 had a higher incidence of composite cardiac events after stenting (adjusted hazard ratio (HR) 3.31, 95% confidence interval (CI) 1.07-10.22, < 0.05).

CONCLUSIONS

RHI assessment through PAT could be a promising method to predict PMI before the procedure. RHI is associated with increased risk of long-term adverse cardiac events after DES implantation.

摘要

背景

经皮冠状动脉介入治疗（PCI）围手术期心肌损伤（PMI）是最常见的并发症。PMI 下的微栓塞和炎症可能导致冠状动脉微血管功能障碍（CMD），反之亦然。通过外周动脉张力测定（PAT）评估的反应性充血指数（RHI）已被认为是一种评估内皮功能和 CMD 的非侵入性方法，可用于预测 PMI。

方法

纳入 268 例疑似稳定型冠状动脉疾病（CAD）并计划行选择性冠状动脉造影的患者。在造影前使用 Endo-PAT2000™ 设备测量 RHI。进一步评估 RHI 与 PMI 及心血管事件之间的关系。

结果

在该队列中，189 例（70.5%）患者诊断为 CAD，119 例（44.4%）患者接受药物洗脱支架（DES）植入。与无 CAD 患者相比，CAD 患者的 RHI 较低（1.88±0.55 比 2.02±0.58， < 0.05）。PMI 患者造影前 RHI 较低（1.75±0.37 比 1.95±0.50， < 0.05）。RHI 的受试者工作特征曲线分析显示曲线下面积（AUC）为 0.61，预测 PMI 的灵敏度为 62.7%，特异性为 50.0%。此外，我们发现 RHI≤1.81 的 CAD 患者支架置入后复合心脏事件发生率较高（调整后的危险比（HR）为 3.31，95%置信区间（CI）为 1.07-10.22， < 0.05）。