Vera Cruz Patrick, Palmes Patricio, Bacalangco Nadine
HB Calleja Heart and Vascular Institute, St Luke's Medical Center Quezon City, Manila, the Philippines.
Department of Internal Medicine, West Visayas State University Medical Center Iloilo Ciy, Iloilo, the Philippines.
Interv Cardiol. 2022 Jul 21;17:e10. doi: 10.15420/icr.2022.01. eCollection 2022 Jan.
Ineffective myocardial perfusion despite angiographic success after angioplasty occurs frequently and is associated with an increased risk of mortality. Hence, this study determined whether myocardial perfusion measured by myocardial blush grade (MBG) identifies ST-elevation MI (STEMI) patients at high risk for poor outcomes after successful angioplasty. The search employed strategies designed for research databases. An article was eligible if it included adults who underwent coronary angioplasty for STEMI, post-angioplasty MBG was assessed, and mortality or major adverse cardiovascular events (MACE) were determined. Risk for bias was assessed using the Quality In Prognosis Studies tool and forest plots in a Mantel-Haenszel fixed effects model were created using RevMan5.4. Eight observational studies with an overall low risk of bias were included, involving 8,044 patients. MBG 0/1 with no to poor myocardial perfusion had a negative prognostic value for mortality (OR 2.68; 95% CI [2.22-3.23]) and MACE (OR 1.20; 95% CI [1.01-1.41]). Furthermore, MBG 2 with moderate myocardial perfusion and MBG 3 with normal myocardial perfusion were associated with increased survival with a logHR of 0.47 (95% CI [0.43-0.52]) and 0.20 percutaneous coronary intervention (95% CI [0.18-0.23]). These results imply MBG is a useful prognostic marker for STEMI patients. MBG 0/1 after primary angioplasty is a strong negative prognostic marker for long-term all-cause mortality and MACE among STEMI patients, and a post-primary angioplasty MBG of 2 or 3 is a robust prognostic marker for long-term survival.
尽管血管成形术后血管造影显示成功，但心肌灌注无效仍频繁发生，并与死亡风险增加相关。因此，本研究确定通过心肌 blush 分级（MBG）测量的心肌灌注是否能识别成功血管成形术后预后不良的 ST 段抬高型心肌梗死（STEMI）患者。检索采用了针对研究数据库设计的策略。如果一篇文章纳入了因 STEMI 接受冠状动脉血管成形术的成年人、评估了血管成形术后的 MBG 且确定了死亡率或主要不良心血管事件（MACE），则该文章符合条件。使用预后研究质量工具评估偏倚风险，并使用 RevMan5.4 在 Mantel-Haenszel 固定效应模型中创建森林图。纳入了八项总体偏倚风险较低的观察性研究，涉及 8044 名患者。MBG 0/1 表示心肌灌注无至差，对死亡率（OR 2.68；95% CI [2.22 - 3.23]）和 MACE（OR 1.20；95% CI [1.01 - 1.41]）具有负面预后价值。此外，MBG 2 表示心肌灌注中等，MBG 3 表示心肌灌注正常，与生存率增加相关，对数风险比为 0.47（95% CI [0.43 - 0.52]）和 0.20 经皮冠状动脉介入治疗（95% CI [0.18 - 0.23]）。这些结果表明 MBG 是 STEMI 患者有用的预后标志物。初次血管成形术后 MBG 0/1 是 STEMI 患者长期全因死亡率和 MACE 的强负面预后标志物，初次血管成形术后 MBG 为 2 或 3 是长期生存的有力预后标志物。
