急性冠状动脉综合征的标志物：经皮冠状动脉介入治疗时的冠状动脉远端栓塞

Markers in Acute Coronary Syndrome: Distal Coronary Embolism at Percutaneous Coronary Intervention.

作者信息

Semerdzhieva Niya Emilova, Dimitrov Simeon, Tsakova Adelina, Gospodinova Mariana, Atanasov Petar, Lozanova Vesela

机构信息

Clinic of Internal Medicine, University Emergency Hospital 'Pirogov', 1606 Sofia, Bulgaria.

Clinic of Cardiology, Department of Interventional Cardiology, Hospital 'Hristo Botev', 3001 Vratza, Bulgaria.

出版信息

J Cardiovasc Dev Dis. 2025 Aug 19;12(8):315. doi: 10.3390/jcdd12080315.

DOI:10.3390/jcdd12080315

PMID:40863381

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12386391/

Abstract

(1) Introduction: Distal coronary emboli occur in up to 15-30.5% of patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and are associated with poor myocardial reperfusion in the territory of the infarct-related artery. The objective of this study was to analyze the possible laboratory, clinical and imaging indicators of distal coronary embolism detected with an angiography at the time of PCI with stent implantation for acute coronary syndrome (ACS). (2) Methods: This analysis included 137 patients with ACS. The levels of cardiac enzymes (creatine kinase [CK], muscle-brain fraction of CK, high-sensitivity troponin T [hsTnT]), inflammatory markers (high-sensitivity C-reactive protein, white blood cell counts), sex steroids (total 17β-estradiol, total testosterone, dehydroepiandrosterone sulfate [DHEA-S]), serum lipids and oxidized low-density lipoproteins (oxLDL) were measured and analyzed for their relationship with the incidence of distal coronary embolism at PCI. (3) Results: Slow coronary blood flow was detected in the coronary artery subject to intervention in 9.4% ( = 13) of patients. Triglyceride (TG), high-density lipoprotein (HDL), glucose and serum DHEA-S levels were found to be associated with distal coronary embolization and slow coronary flow at PCI with stenting (DHEA-S: 1.316, OR 1.044-1.659, = 0.020; TG: 1.130, OR 0.990-1.300, = 0.072; HDL: 2.326, OR 0.918-5.8977, = 0.075; glucose: 1.130, OR 0.990-1.300, = 0.072). In the multivariable model, only DHEA-S after PCI tended to indicate a risk of distal coronary embolism (DHEA-S: = 0.071; TG: = 0.339; glucose: = 0.582; HDL: = 0.502). (4) Conclusions: Patients with ACS with higher triglyceride levels are at risk of developing slow blood flow after percutaneous intervention with stent implantation. Elevated DHEA-S possibly reflects sympathoadrenal and hypothalamus-pituitary-adrenal hyperactivity associated with ACS and coronary intervention.

摘要

(1) 引言：在接受经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者中，冠状动脉远端栓塞发生率高达15% - 30.5%，且与梗死相关动脉区域心肌再灌注不良有关。本研究的目的是分析在急性冠状动脉综合征（ACS）患者接受PCI并植入支架时，通过血管造影检测到的冠状动脉远端栓塞可能的实验室、临床和影像学指标。(2) 方法：本分析纳入了137例ACS患者。检测并分析了心肌酶（肌酸激酶[CK]、CK的肌脑同工酶、高敏肌钙蛋白T[hsTnT]）、炎症标志物（高敏C反应蛋白、白细胞计数）、性激素（总17β - 雌二醇、总睾酮、硫酸脱氢表雄酮[DHEA - S]）、血脂和氧化型低密度脂蛋白（oxLDL）水平，并分析它们与PCI时冠状动脉远端栓塞发生率的关系。(3) 结果：9.4%（n = 13）的患者在接受介入治疗的冠状动脉中检测到冠状动脉血流缓慢。发现甘油三酯（TG）、高密度脂蛋白（HDL）、血糖和血清DHEA - S水平与PCI植入支架时冠状动脉远端栓塞和冠状动脉血流缓慢有关（DHEA - S：1.316，OR 1.044 - 1.659，P = 0.020；TG：1.130，OR 0.990 - 1.300，P = 0.072；HDL：2.326，OR 0.918 - 5.8977，P = 0.075；血糖：1.130，OR 0.990 - 1.300，P = 0.072）。在多变量模型中，仅PCI术后的DHEA - S倾向于提示冠状动脉远端栓塞风险（DHEA - S：P = 0.071；TG：P = 0.339；血糖：P = 0.582；HDL：P = 0.502）。(4) 结论：甘油三酯水平较高的ACS患者在接受支架植入的经皮介入治疗后有发生血流缓慢的风险。DHEA - S升高可能反映了与ACS和冠状动脉介入相关的交感肾上腺及下丘脑 - 垂体 - 肾上腺系统的过度活跃。