TIMI心肌灌注帧数在STEMI患者PCI术后MVO评价中的应用

目的〖KG*2〗探索TIMI心肌灌注帧数（TIMI myocardial perfusion frame count,TMPFC）在急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者急诊经皮冠状动脉支架植入术（percutaneous coronary intervention，PCI）后心肌微循环障碍(microvascular obstruction,MVO) 评价中的价值及其同临床预后的关系。 〖HTH〗方法〖KG*2〗选择STEMI并成功行急诊PCI的住院患者200例，支架术后依据TMPFC评分分为观察组82例和对照组118例，比较2组临床资料和PCI相关资料， PCI术后6个月随访观察左心室射血分数（left ventricular ejection fraction，LVEF）和主要心血管不良事件（major cardiovascular adverse events，MACE）发生情况。 〖HTH〗结果〖KG*2〗观察组患糖尿病发生率、血糖、肌钙蛋白I峰值、MACE发生率高于对照组，梗死前心绞痛发生率、基线LVEF、6个月LVEF低于对照组，差异有统计学意义（P＜0.05）。观察组发病至首次医疗接触时间长于对照组，支架后扩张、多支病变、抽吸导管使用、冠状动脉内注射血小板Ⅱb/Ⅲa受体拮抗剂、TMPFC高于对照组，TIMI 3级、TMPG 3级占比低于对照组，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，cTnI峰值和发病至首次医疗接触时间是MVO发生的危险因素（OR=1.014，95%CI：0.951~1.082；OR=1.368，95%CI：1.149~1.627）；TMPFC是STEMI患者6个月发生MACE的危险因素（OR=1.040，95%CI：1.007~1.092）。 〖HTH〗结论〖KG*2〗TMPFC是接受PCI的STEMI患者MACE发生的独立危险因素，其作为一种新的微循环定量评价指标优于以往心肌微循环影像学指标。

Application of TIMI myocardial perfusion frame number in MVO evaluation of STEMI patients after PCI

ObjectiveTo explore the value of TIMI myocardial perfusion frame count(TMPFC) in the evaluation of microvascular obstruction after primary percutaneous coronary stenting(PCI) in patients with ST-segment elevation myocardial infarction(STEMI) and its relationship with clinical prognosis. MethodsA total of 200 STEMI patients with primary PCI were selected and divided into two groups according to TMPFC. Baseline clinical characteristics and angiographic characteristics of the two groups were observed, and the left ventricular ejection fraction(LVEF) and major cardiovascular adverse events(MACE) were followed up 6 months after PCI. ResultsThe incidence of diabetes, blood glucose, peak cardiac troponin I(CTnI) and MACE in the observation group was higher than that in the control group, while the incidence of pre-infarction angina, baseline LVEF and 6-month LVEF was lower than that in the control group(P＜0.05). In the observation group, the onset to first medical contact time(Onset to FMC) was longer than that in the control group; Post-stent dilation, aspiration catheter, intra-coronary platelet Ⅱb/Ⅲa receptor antagonists, multi-vessel disease, TMPFC were higher than those in the control group. The proportion of TIMI level 3, and TMPG level 3 was lower than that of the control group(P＜0.05). Onset-to-FMC and peak CTnI were independent risk factors for myocardial microcirculation obstruction(OR=1.368, 95%CI:1.149-1.627， P＜0.001; OR=1.014, 95%CI:0.951-1.082; P=0.005), and TMPFC were independent risk factors for MACE in STEMI patients after 6 months follow-up(OR=1.040, 95%CI:1.007-1.092, P=0.020). ConclusionTMPFC was independent risk factors for MACE in STEMI patients undergoing PCI, and as a new quantitative evaluation index of microcirculation, TMPFC was superior to the previous imaging index of myocardial microcirculation.