Department of Cardiology, Peking University People's Hospital, Beijing, China.
Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Beijing, China.
BMC Cardiovasc Disord. 2022 Dec 28;22(1):572. doi: 10.1186/s12872-022-02947-5.
The mortality rate of acute ST-segment elevation myocardial infarction (STEMI) remains substantial, despite advances in treatment strategies. Coronary microcirculation dysfunction (CMD) persists after percutaneous coronary intervention (PCI) in a substantial proportion of STEMI patients. The association between CMD assessed using myocardial contrast echocardiography (MCE) and prognosis requires further elucidation. This study aimed to evaluate the impact of CMD after successful PCI on the prognosis of patients with STEMI.
We enrolled 167 patients with STEMI after PCI who underwent MCE during hospitalization between January 2018 and March 2022. Patients were classified into the CMD and non-CMD groups according to the results of MCE. The clinical data and MCE results of both groups were analyzed. Follow-up was conducted for major adverse cardiac events.
MCE detected CMD in 105 patients (62.9%). The CMD group contained fewer hypertensive patients (55.2% versus 74.2%, P = 0.015). Patients with CMD exhibited significantly higher levels of plasma troponin I (TnI) [73.2 (23.0-124.0) versus 28.9 (12.7-80.2) ng/mL, P = 0.004], higher levels of plasma B-type natriuretic peptide [255 (99-641) versus 193 (59-389) pg/mL, P = 0.004], poorer Killip classification (P = 0.038), and different culprit vessels (P < 0.001) compared to the non-CMD group. Patients with CMD exhibited lower left ventricular ejection fraction [50 (43-58) versus 61 (54-67) %, P < 0.001], poorer wall motion score index values (1.68 ± 0.4 versus 1.31 ± 0.26, P < 0.001) and poorer left ventricular global longitudinal strain [-11.2 (-8.7 to -14.1) versus -13.9 (-11.0 to -17.2) %, P < 0.001] compared to the non-CMD group. Patients underwent follow-up for 13 (7-20) months. After adjusting for hypertension, peak TnI level, culprit vessel, and Killip classification, CMD was an independent predictor of total major adverse cardiac events at 13 months' follow-up [adjusted odds ratio (OR), 2.457; 95% confidence interval (CI), 1.042-5.790; P = 0.040], and patients with CMD had a higher risk of hospitalization for heart failure (adjusted OR, 5.184; 95% CI, 1.044-25.747; P = 0.044) and repeat myocardial infarction (adjusted OR, 2.896; 95% CI, 1.109-7.565; P = 0.030).
MCE is a safe and effective method for detecting CMD in patients with STEMI. CMD detected by MCE after successful PCI in patients with STEMI is a common occurrence, which is associated with a significantly worse prognosis, especially hospitalization for heart failure and repeat myocardial infarction.
尽管治疗策略有所进步，但急性 ST 段抬高型心肌梗死（STEMI）的死亡率仍然很高。在很大一部分 STEMI 患者中，经皮冠状动脉介入治疗（PCI）后仍存在冠状动脉微循环功能障碍（CMD）。使用心肌对比超声心动图（MCE）评估 CMD 与预后之间的关系仍需要进一步阐明。本研究旨在评估成功 PCI 后 STEMI 患者 CMD 对预后的影响。
我们纳入了 2018 年 1 月至 2022 年 3 月期间住院期间接受 MCE 的 167 例成功 PCI 的 STEMI 患者。根据 MCE 的结果，将患者分为 CMD 组和非 CMD 组。分析两组的临床资料和 MCE 结果。对主要不良心脏事件进行随访。
MCE 检测到 105 例患者（62.9%）存在 CMD。CMD 组中高血压患者比例较低（55.2%比 74.2%，P=0.015）。CMD 组患者的血浆肌钙蛋白 I（TnI）水平显著更高[73.2（23.0-124.0）比 28.9（12.7-80.2）ng/mL，P=0.004]，血浆 B 型利钠肽水平更高[255（99-641）比 193（59-389）pg/mL，P=0.004]，Killip 分级更差（P=0.038），罪犯血管不同（P<0.001）。CMD 组患者的左心室射血分数更低[50（43-58）比 61（54-67）%，P<0.001]，壁运动评分指数值更低（1.68±0.4 比 1.31±0.26，P<0.001），左心室整体纵向应变更差[-11.2（-8.7 至-14.1）比-13.9（-11.0 至-17.2）%，P<0.001]。
患者接受了 13（7-20）个月的随访。在校正高血压、峰值 TnI 水平、罪犯血管和 Killip 分级后，CMD 是 13 个月随访时总主要不良心脏事件的独立预测因素[校正优势比（OR），2.457；95%置信区间（CI），1.042-5.790；P=0.040]，并且 CMD 患者因心力衰竭住院（校正 OR，5.184；95%CI，1.044-25.747；P=0.044）和再发心肌梗死（校正 OR，2.896；95%CI，1.109-7.565；P=0.030）的风险更高。
MCE 是检测 STEMI 患者 CMD 的一种安全有效的方法。在 STEMI 患者中成功 PCI 后，MCE 检测到的 CMD 较为常见，与预后明显恶化相关，尤其是心力衰竭和再发心肌梗死的住院率更高。
