Lianyungang Clinical Medical College of Nanjing Medical University, Lianyungang, Jiangsu, China.
Lianyungang Clinical Medical College of Jinzhou Medical University, Lianyungang, Jiangsu, China.
BMC Cardiovasc Disord. 2022 Sep 14;22(1):410. doi: 10.1186/s12872-022-02836-x.
Some coronary artery angiography (CAG) scores are associated with the no-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). However, quality evidence regarding the association between the CAG scores and microvascular injury is still needed. Our study aimed to validate the ability of the CAG scores in predicting microvascular obstruction (MVO) detected by cardiac magnetic resonance (CMR) imaging.
From October 2020 to October 2021, 141 consecutive patients with acute STEMI who underwent primary PCI and CMR were retrospectively reviewed. CMR imaging was performed between 3 and 7 days after PCI. The patients were divided into MVO and non-MVO group based on the CMR results. Three CAG scores (SYNTAX score, SYNTAX II score and Gensini score) were used to assess the severity of coronary artery atherosclerotic burden.
A total of 122 patients were included (mean age 60.6 ± 12.8 years). MVO occurred in 51 patients (41.8%). Patients with MVO had higher SYNTAX scores, SYNTAX II scores and Gensini scores than those without MVO (all p < 0.001). The Gensini score (r = 0.567, p < 0.001) showed the strongest correlation with infarction size than SYNTAX score (r = 0.521, p < 0.001) and SYNTAX II score (r = 0.509, p < 0.001). The areas under the receiver operator characteristic curves of SYNTAX score, SYNTAX II score and Gensini score for predicting MVO patients were 0.726, 0.774 and 0.807. In multivariable regression analysis, peak troponin I (odd ratio [OR] = 1.236, p = 0.001) and SYNTAX II score (OR = 11.636, p = 0.010) were identified as independent predictors of MVO.
In patients with acute STEMI undergoing primary PCI treatment, the peak troponin I and SYNTAX II score may be an independent predictor of MVO.
一些冠状动脉造影（CAG）评分与急性 ST 段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后的无复流现象有关。然而，关于 CAG 评分与微血管损伤之间关联的高质量证据仍有待证实。我们的研究旨在验证 CAG 评分预测心脏磁共振（CMR）成像检测到的微血管阻塞（MVO）的能力。
回顾性分析 2020 年 10 月至 2021 年 10 月期间 141 例接受直接 PCI 和 CMR 的急性 STEMI 连续患者。PCI 后 3 至 7 天进行 CMR 成像。根据 CMR 结果将患者分为 MVO 和非 MVO 组。使用 3 种 CAG 评分（SYNTAX 评分、SYNTAX II 评分和 Gensini 评分）评估冠状动脉粥样硬化负担的严重程度。
共纳入 122 例患者（平均年龄 60.6±12.8 岁）。51 例患者发生 MVO（41.8%）。与无 MVO 患者相比，MVO 患者的 SYNTAX 评分、SYNTAX II 评分和 Gensini 评分更高（均 p<0.001）。Gensini 评分（r=0.567，p<0.001）与梗死面积的相关性最强，优于 SYNTAX 评分（r=0.521，p<0.001）和 SYNTAX II 评分（r=0.509，p<0.001）。SYNTAX 评分、SYNTAX II 评分和 Gensini 评分预测 MVO 患者的受试者工作特征曲线下面积分别为 0.726、0.774 和 0.807。多变量回归分析显示，肌钙蛋白 I 峰值（比值比[OR] = 1.236，p=0.001）和 SYNTAX II 评分（OR=11.636，p=0.010）是 MVO 的独立预测因素。
在接受直接 PCI 治疗的急性 STEMI 患者中，肌钙蛋白 I 峰值和 SYNTAX II 评分可能是 MVO 的独立预测因素。
