新冠肺炎合并急性冠状动脉综合征患者的微血管功能障碍

Microvascular Dysfunction in COVID-19 Patients with Acute Coronary Syndrome.

作者信息

Kalender Erol, Dogan Gunes Melike, Keskin Kudret, Sigirci Serhat, Sumerkan Mutlu Cagan, Ser Ozgur Selim, Alyan Omer

机构信息

Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.

出版信息

Sisli Etfal Hastan Tip Bul. 2023 Sep 29;57(3):367-373. doi: 10.14744/SEMB.2023.92074. eCollection 2023.

DOI:10.14744/SEMB.2023.92074

PMID:37900331

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10600601/

Abstract

OBJECTIVE

Coronavirus disease 2019 (COVID-19) is considered to deteriorate endothelial function through hyperinflammation. We aimed to investigate microvascular dysfunction using the angiographic parameters thrombolysis in myocardial infarction frame count (TFC) and myocardial blush grade (MBG), in COVID-19 patients with acute coronary syndrome (ACS).

METHODS

One hundred and sixty-five patients presented with ACS (62.4% ST elevated myocardial infarction) and underwent percutaneous coronary intervention between March 1 and June 30, 2020, were enrolled in the study. The polymerase chain reaction test was performed in case of suggestive symptoms or typical computerized tomography findings.

RESULTS

Twenty-six patients (15.7%) were tested positive for COVID-19. Significantly higher values were observed in TFC in patients with COVID-19 (p<0.001), whereas COVID-19 patients had significantly lower MBGs (Grade 0 and 1) (p<0.001). Peak troponin-I value was also higher in the COVID-19 group (27335 vs. 15959 ng/dL, p=0.006). Mortality risk was higher in COVID-19 patients (38.4% vs. 7.2%, p<0.001). TFC and ejection fraction may predict in-hospital mortality among COVID-19 patients with ACS according to logistic regression results. In correlation analysis, TFC correlated positively with C-reactive protein (r=0.340, p<0.001) and peak troponin-I value (r=0.369, p<0.001).

CONCLUSION

COVID-19 is associated with slow coronary flow and microvascular impairment in ACS.

摘要

目的

2019冠状病毒病（COVID-19）被认为会通过过度炎症反应使内皮功能恶化。我们旨在利用血管造影参数心肌梗死溶栓帧数（TFC）和心肌 blush 分级（MBG），对患有急性冠状动脉综合征（ACS）的COVID-19患者的微血管功能障碍进行研究。

方法

本研究纳入了2020年3月1日至6月30日期间出现ACS（62.4%为ST段抬高型心肌梗死）并接受经皮冠状动脉介入治疗的165例患者。出现提示性症状或典型计算机断层扫描结果时进行聚合酶链反应检测。

结果

26例患者（15.7%）COVID-19检测呈阳性。COVID-19患者的TFC值显著更高（p<0.001），而COVID-19患者的MBG显著更低（0级和1级）（p<0.001）。COVID-19组的肌钙蛋白I峰值也更高（27335对15959 ng/dL，p=0.006）。COVID-19患者的死亡风险更高（38.4%对7.2%，p<0.001）。根据逻辑回归结果，TFC和射血分数可能预测患有ACS的COVID-19患者的住院死亡率。在相关性分析中，TFC与C反应蛋白呈正相关（r=0.340，p<0.001）和肌钙蛋白I峰值（r=0.369，p<0.001）。