Left ventricular mechanical dyssynchrony in patients with impaired left ventricular function undergoing gated SPECT myocardial perfusion imaging

IntroductionGated SPECT myocardial perfusion imaging (MPI) has been used to quantify mechanical dyssynchrony. Mechanical dyssynchrony appears to be related to response to cardiac resynchronization therapy.ObjectiveTo evaluate the presence and predictors of mechanical dyssynchrony in patients with impaired left ventricular function (LVEF) ≤50%.MethodsThe study included 143 consecutive patients referred for gated SPECT MPI with LVEF ≤50%. Gated SPECT MPI was performed according to a stress/rest protocol acquiring images with Tc 99m-tetrofosmin. Emory Cardiac Toolbox software was used for phase analysis and a standard deviation (SD) ≥43° was considered to indicate mechanical dyssynchrony.ResultsMechanical dyssynchrony was present in 53.1% of the patients. Its predictors were diabetes (OR 2.0, p≤0.05), summed stress score (OR 1.1, p≤0.0005), summed rest score (OR 1.1, p≤0.0001), end-diastolic volume (OR 1.0, p≤0.0001), LVEF (OR 0.9, p≤0.0001), LVEF ≤35% (OR 3.1, p≤0.005) and LVEF ≤35% and QRS ≥120 ms (OR 3.5, p≤0.05). In this study QRS width and QRS ≥120 ms were not predictors of mechanical dyssynchrony.ConclusionsMyocardial perfusion imaging can be used to assess mechanical dyssynchrony. In patients with impaired ventricular function mechanical dyssynchrony was highly prevalent and was related to parameters of left ventricular function and perfusion.     

Associations between perfusion defects,tissue changes and myocardial deformation in hypertrophic cardiomyopathy,uncovered by a cardiac magnetic resonance segmental analysis

BackgroundMicrovascular dysfunction is an often overlooked feature of hypertrophic cardiomyopathy (HCM). Our aim was to assess the association between microvascular dysfunction, wall thickness, tissue characteristics and myocardial deformation in HCM patients, by analyzing individual myocardial segments.MethodsProspective assessment including cardiac magnetic resonance to assess wall thickness, T1 and T2 mapping, extracellular volume, late gadolinium enhancement (LGE) and stress perfusion. Results were stratified according to the 16 American Heart Association segments.ResultsSeventy-five patients were recruited (1200 segments), 63% male, mean age 54.6±14.8 years, maximal wall thickness of 20.22±4.6 mm. Among the 424 segments (35%) with perfusion defects, 24% had defects only in the endocardial layer and 12% in both endocardial and epicardial layers. Perfusion defects were more often detected in hypertrophied segments (64%). Among the 660 segments with normal wall thickness, 19% presented perfusion defects. Independently of wall thickness, segments with perfusion defects had a higher T1 (β-estimate 30.28, p<0.001), extracelluar volume (β-estimate 1.50, p<0.001) and T2 (β-estimate 0.73, p<0.001) and had late gadolinium enhancement more frequently (odds ratio 4.16, p<0.001). Higher values of circumferential strain (lower deformation) and lower values of radial strain were found in segments with perfusion defects (β-estimate 2.76, p<0.001; and β-estimate -10.39, p<0.001, circumferential and radial strain, respectively).ConclusionWhile microvascular dysfunction was more prevalent in more hypertrophied segments, it also had a major presence in segments without hypertrophy. In this segmental analysis, we found an association between the presence of ischemia and tissue abnormalities, replacement fibrosis as well as impaired strain, independently of the segmental wall thickness.     

KAsH: A new tool to predict in-hospital mortality in patients with myocardial infarction

IntroductionComplex risk scores have limited applicability in the assessment of patients with myocardial infarction (MI). In this work, the authors aimed to develop a simple to use clinical score to stratify the in-hospital mortality risk of patients with MI at first medical contact.MethodsIn this single-center prospective registry assessing 1504 consecutively admitted patients with MI, the strongest predictors of in-hospital mortality were selected through multivariate logistic regression. The KAsH score was developed according to the following formula: KAsH=(Killip class×Age×Heart rate)/systolic blood pressure. Its predictive power was compared to previously validated scores using the DeLong test. The score was categorized and further compared to the Killip classification.ResultsThe KAsH score displayed excellent predictive power for in-hospital mortality, superior to other well-validated risk scores (AUC: KAsH 0.861 vs. GRACE 0.773, p<0.001) and robust in subgroup analysis. KAsH maintained its predictive capacity after adjustment for multiple confounding factors such as diabetes, heart failure, mechanical complications and bleeding (OR 1.004, 95% CI 1.001-1.008, p=0.012) and reclassified 81.5% of patients into a better risk category compared to the Killip classification.KAsH's categorization displayed excellent mortality discrimination (KAsH 1: 1.0%, KAsH 2: 8.1%, KAsH 3: 20.4%, KAsH 4: 55.2%) and better mortality prediction than the Killip classification (AUC: KAsH 0.839 vs. Killip 0.775, p<0.0001).ConclusionKAsH, an easy to use score calculated at first medical contact with patients with MI, displays better predictive power for in-hospital mortality than existing scores.     

腺苷负荷心肌灌注显像正常女性中心电图呈缺血改变35例分析

目的:探讨腺苷负荷心电图(ECG)呈缺血性改变而核素心肌灌注显像(MPI)正常的女性患者,MPI和冠状动脉CT(CTCA)结果对冠心病(CAD)诊断的临床价值。方法:回顾性分析2008年5月至2011年11月疑诊冠心病行腺苷负荷/静息MPI的4 142例女性患者资料,将其中35例〔年龄39～76岁,平均年龄(55.74±9.43)岁〕腺苷负荷ECG呈缺血改变,但MPI正常者作为研究对象,35例患者均利用SPECT/CT行MPI和同机CTCA检查,其中1例患者在1个月内行冠状动脉造影(CAG)检查。结果:35例患者静息状态ECG均正常,腺苷负荷ECG则出现ST段水平或下斜型下移≥0.1 mV,停止负荷1 min后ECG恢复正常,提示心肌缺血改变,随后的负荷/静息MPI均未见心肌缺血改变。同机CTCA结果示:27例冠状动脉正常(27/35,77.1%),7例冠状动脉粥样硬化性改变(7/35,20.0%),1例(2.9%)为3支冠状动脉狭窄性病变,程度均≥50%,其CAG显示:LAD近段狭窄75%,LCX中段狭窄90%,RCA近中段狭窄95%。结果提示:此组患者中97.1%的冠状动脉是正常或仅呈硬化性改变,而无心肌缺血存在。结论:女性患者易出现负荷ECG"假阳性";负荷MPI是评价此类患者有无冠心病的重要手段;同机CTCA则是避免冠状动脉3支病变而MPI"假阴性"的弥补手段,因此,利用SPECT/CT施行同机MPI/CTCA是对此类患者进行冠心病筛查的准确性较高的无创性评价手段。     

Left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction and low-risk GRACE score: Prevalence,clinical outcomes and predictors

Introduction

A low-risk GRACE score identifies patients with a lower incidence of major cardiac events, however it can erroneously classify patients with severe coronary artery disease as low-risk. We assessed the prevalence, clinical outcomes and predictors of left main and/or three-vessel disease (LM/3VD) in non-ST-elevation acute myocardial infarction (NSTEMI) patients with a GRACE score of ≤108 at admission.

不同性别患者负荷心电图缺血改变与心肌血供及冠状动脉病变的关系

目的:探讨腺苷负荷试验心电图(ECG)呈缺血性改变患者中,其性别间差异与冠状动脉病变及心肌血供受损之间的相互关系及临床意义。方法:回顾性分析2008年5月至2012年11月,本院疑诊冠心病行腺苷负荷/静息心肌灌注显像(MPI)的7 826例患者的资料,以腺苷负荷试验中ECG呈缺血改变的104例患者为研究对象,男性:女性为24:80,平均年龄(58.76±9.97)岁,其中62例患者在1个月内行冠状动脉造影检查(CAG)。结果:104例患者腺苷负荷试验ECG出现ST段水平或下斜型下移≥0.1mV,随后的MPI显示:阳性66例(男性18例),阴性38例(男性32例,P=0.181)。MPI阳性的患者中有33例(男性14例)同期施行了CAG,结果提示:仅1例女性患者冠状动脉呈粥样硬化性改变,但无明显狭窄性病变;另32例(97.0%)均有至少1支冠状动脉狭窄≥50%病变(男性100%,女性94.7%,P=0.576)。MPI阴性的患者中有29例(男性4例)行CAG,结果提示:男性2例(50%)、女性24例(96%)冠状动脉正常或病变50%,余下2例男性(50%)和1例女性(4%)为3支冠状动脉窄性病变程度均≥50%(P=0.042)。结论:腺苷负荷ECG呈缺血性改变时,MPI阳性或阴性的发生率与性别无明显相关;冠状动脉有严重狭窄性病变且MPI阳性的发生率亦与性别无明显相关;但MPI阴性提示无心肌缺血,而存在严重冠状动脉狭窄性病变的男性明显高于女性。因此对此类男性患者进行临床诊断和评价时要特别慎重,必要时行冠状动脉造影检查。     

Accuracy of the TIMI and GRACE scores in predicting coronary disease in patients with non-ST-elevation acute coronary syndrome

Introduction

The GRACE and TIMI scores have been well validated for assessment of prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, their value in predicting coronary artery disease (CAD) has been little studied. We aimed to assess the relationship between these scores and the extent of coronary disease.

Prediction of decrease in myocardial perfusion defect size and severity during a 3-month follow-up by the degree of acute resolution of electrocardiographic changes

Myocardial perfusion in infarct-related artery (IRA) distribution improves progressively until a few months after successful reperfusion therapy. We assessed the rate of electrocardiographic (ECG) stage dynamics to predict perfusion improvement after mechanical, thrombolytic, or spontaneous recanalization of IRA. Thirteen patients were divided into group A (n = 8, with > or = 2 ECG stages per 2-day change rate) and group B (n = 5, no rapid change of ECG stages). There were no significant technetium Tc 99m sestamibi scintigraphic differences between the groups 3 days after recanalization; however, after 3 months, perfusion deficit size (2.8 +/- 1.8 vs 4.8 +/- 1.2, P < or = .03) and severity (1.8 +/- 0.9 vs 3.0 +/- 0, P < or = .03) were smaller in group A vs group B. The prediction sensitivity of the method was 87.5% for decrease in size and 100% for decrease in severity of perfusion defect; the specificity was 80% and 100%, respectively. A change rate of 2 or more ECG stages per 2 days predicts follow-up improvement of myocardial perfusion after IRA recanalization.     

The presence of fragmented QRS is associated with increased epicardial adipose tissue and subclinical myocardial dysfunction in healthy individuals

Aim

The aim of this study was to measure epicardial adipose tissue (EAT) and to assess left ventricular (LV) systolic and diastolic function in a healthy population grouped according to the presence of fragmented QRS (fQRS).

Association between copeptin and contrast-induced nephropathy in patients with ST-elevation myocardial infarction

ObjectiveThe aim of this study was to investigate the predictive value of copeptin levels in the development of contrast-induced nephropathy (CIN).MethodsA total of 274 patients diagnosed with ST-elevation myocardial infarction (STEMI) and who had undergone primary percutaneous coronary intervention were included in the study. The patients were divided into two groups according to the presence (CIN+) or absence (CIN-) of CIN. These groups were compared in terms of demographic characteristics, laboratory findings and risk factors.ResultsCopeptin levels (10.68±6.43 vs. 7.07±05.53 pmol/l; p<0.001) and peak creatinine (1.46±1.20 vs. 1.03±0.20 mg/dl; p=0.005) were significantly higher in the CIN+ group than in the CIN- group. Female gender was significantly more prevalent in the CIN- group compared to the CIN+ group (19% vs. 8.6%; p<0.05). Copeptin level at hospital admission (OR: 2.36, p=0.005) was found to be an independent predictor for CIN development.ConclusionCopeptin level is an independent predictor of CIN development in patients with acute STEMI that can be detected rapidly and easily. This result indicates that physicians should be aware of the possibility of CIN development in patients with high copeptin levels and preventive measures should start early.     

Ventricular arrhythmias are associated with increased QT interval and QRS dispersion in patients with ST-elevation myocardial infarction

Introduction and ObjectivesThe electrocardiogram continues to be essential in the diagnosis of acute myocardial infarction, and a useful tool in arrhythmic risk stratification. We aimed to determine which electrocardiographic variables can successfully predict the occurrence of ventricular arrhythmias (VA) in patients following ST-segment elevation myocardial infarction (STEMI).MethodsWe performed an observational study including 667 patients with STEMI admitted to the University Hospital in Sancti Spíritus, Cuba. Demographic variables, cardiovascular risk factors, and clinical variables were recorded. Electrocardiographic variables included QT interval duration (measured and corrected) and QT dispersion, QRS duration and dispersion, JT interval duration and ST-segment elevation magnitude. We also determined left ventricular ejection fraction and glomerular filtration rate. A binary statistical regression model and a regression tree were used to determine the variables that successfully predicted VA.ResultsVA occurred in 92 (13.8%) patients, within the first 48 hours in 68 (73.9%) and after this period in 24 (26.1%) patients. The variables associated with VA were QT interval duration >529 ms and QT dispersion >66 ms, QRS dispersion >50 ms, and the presence of ST-segment elevation in six or more leads.ConclusionsThe main predictor of VA occurring during the initial 48 hours was QT interval duration, while, after this period, it was QRS dispersion.     

Prognostic value of brain natriuretic peptide in ST-elevation myocardial infarction patients: A Portuguese registry

IntroductionBrain natriuretic peptide (BNP) is a highly sensitive and specific biomarker for the extent of myocardial infarction that is strongly related to short- and long-term prognosis in patients with acute coronary syndromes.ObjectiveTo assess the prognostic value of BNP levels in a Portuguese cohort of ST-elevation myocardial infarction (STEMI) patients.MethodsWe performed a retrospective analysis of patients admitted with STEMI included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 2019. Patients were divided into three groups according to BNP level (<100 pg/ml, 100-399 pg/ml and ≥400 pg/ml) and compared. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression. For sample homogenization, propensity score matching and pairwise matching with a tolerance level of 0.005 were performed.ResultsA total of 1650 patients were included, of whom 21.5% presented high BNP levels (≥400 pg/ml). These were older and had more comorbidities, lower admission systolic blood pressure and hemoglobin, higher heart rate, Killip class and creatinine, worse left ventricular systolic function and severe coronary anatomy. Higher BNP was associated with more in-hospital complications, in-hospital mortality and adverse outcomes at one year.ConclusionBNP levels during the index hospitalization were a powerful prognostic biomarker for all-cause mortality and major adverse cardiac events in patients admitted with STEMI to Portuguese hospitals.     

Echocardiographic assessment of right ventricular contractile reserve in patients with pulmonary hypertension

Introduction and AimRight ventricular function is a major determinant of prognosis in pulmonary hypertension. The aim of this study was to assess and compare right ventricular contractile reserve in healthy subjects (controls) and in subjects with pulmonary hypertension (cases).MethodsIn this prospective study of seven cases and seven controls undergoing treadmill stress echocardiography, right ventricular S-wave velocity, tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC) and stroke volume index were assessed at rest and with exercise. The increase in each parameter between rest and exercise for cases and controls was analyzed and the magnitude of change in each parameter with exercise between cases and controls was compared.ResultsA significant increase in S-wave velocity was observed in cases (rest: 9.4±3.1; exercise: 13.7±4.8 cm/s [p<0.05]). In controls there was a statistically significant increase in S-wave velocity (12.9±2.3 to 23.0±7.2 cm/s [p<0.005]), TAPSE (25.7±2.4 to 31.0±3.5 mm [p<0.05]) and RVFAC (53.8±14.7% to 64.4±9.9% [p<0.005]). The magnitude of change in S-wave velocity (cases: 4.3±3.3; controls: 10.1±5.5 cm/s [p<0.05]), TAPSE (cases: 0.6±2.5; controls: 5.3±3.8 mm [p<0.05]) and RVFAC (cases: −0.4±11.8; controls: 10.6±5.9% [p<0.05]) was significantly different between cases and controls.ConclusionsS-wave velocity, TAPSE and RVFAC increased significantly with exercise in controls. S-wave velocity was the only parameter that showed a significant increase in cases, although the magnitude of this increase was significantly less than in controls.     

The use of reperfusion and revascularization procedures in acute coronary syndrome in Portugal: A systematic review

Introduction and ObjectivesReperfusion and revascularization therapies play an important role in the management of coronary heart disease and have contributed to decreases in case fatality rates. We aimed to describe the use of these therapies for the treatment of acute coronary syndrome (ACS) patients over time in Portugal.MethodsPubMed was searched in July 2012. The proportion of patients treated with fibrinolysis, primary percutaneous coronary intervention (PCI), any PCI and coronary artery bypass grafting (CABG) was described according to type of ACS: STEMI (≥90% patients with ST-segment elevation or Q-wave myocardial infarction), NSTE-ACS (≥90% patients with non-ST-segment elevation ACS) and mixed ACS (all others).ResultsWe identified 41 eligible studies, published between 1989 and 2011. Twenty-eight reported on samples considered representative of ACS patients treated in Portugal. The small number of estimates of the use of each treatment in STEMI and NSTE-ACS patients precluded identification of any time trend. In the last 20 years, the proportion of mixed ACS patients treated with fibrinolysis decreased and the use of PCI increased, while the use of CABG did not change.ConclusionsThe general pattern of the use of reperfusion and revascularization is in accordance with that reported in other developed countries, reflecting a favorable trend in the quality of care of ACS patients. The relatively small number of estimates on the same procedure in comparable patients limits the generalizability of the conclusions, and highlights the need for systematic approaches to monitor the use of treatments over time.     

Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia,Spain

ObjectiveTo assess the association between a comprehensive smoking ban and hospitalization rates for acute myocardial infarction (AMI).MethodsAn observational study was conducted to assess changes in hospital admission rates for AMI in the Autonomous Community of Valencia, Spain (population 5 million), during the period 1995-2013. Law 28/2005 prohibited smoking in all enclosed spaces (public and private), and Law 42/2010 extended the ban to bars and restaurants as well as children's playgrounds and access areas of schools and hospitals. Data on hospital admissions were obtained from the Hospital Discharge Database (CMBD) of the Autonomous Community. Annual hospital admission rates per 100 000 population for AMI (ICD-9-CM code 410) for men and women were calculated.ResultsAdjusted hospital admission rates per 100 000 population for AMI decreased markedly from 141.1 in 2005 to 119.2 in 2007, with a further reduction to 102.9 in 2013. Reductions in hospital admission were recorded in both men and women, but the downward trends were stronger in women.ConclusionThe Spanish comprehensive smoking ban was associated with a marked reduction in the adjusted rate of hospital admissions due to AMI in the Autonomous Community of Valencia. This decrease in the number of persons requiring in-patient care due to AMI is important from both a health care and a societal perspective.     

The impact of diastolic dysfunction as a predictor of cardiovascular events: A systematic review and meta-analysis

IntroductionDiastolic dysfunction is highly prevalent and a key pathophysiological contributor to several cardiovascular diseases, especially heart failure with preserved ejection fraction. In addition, some evidence suggests diastolic dysfunction is a risk factor for major adverse cardiovascular events. This study aimed to systematically review the evidence and to quantify the association between diastolic dysfunction and risk of cardiovascular events and death.MethodsMEDLINE was systematically searched from 1974 up to October 2017. We included cohort studies that assessed diastolic function in adults in the community, providing a definition of diastolic dysfunction regarding the occurrence of any cardiovascular event or mortality. For the quantitative analysis, relative risk estimates comparing individuals with versus without diastolic dysfunction were combined using a random effects model.ResultsNineteen studies were identified for inclusion in the systematic review, assessing a total of 63 802 participants. Nine studies were included in the meta-analysis. Diagnostic criteria and classification of diastolic dysfunction differed substantially between studies. The median prevalence of diastolic dysfunction in studies including individuals with and without diastolic dysfunction was 35.1% (range 5.3-65.2%). Comparing diastolic dysfunction with normal diastolic function, the summary relative risk estimate for cardiovascular events or mortality was 3.53 (95% CI: 2.75-4.53; I²=85.5%; nine studies).ConclusionsAlthough the definitions found in the literature differ, the diagnosis of diastolic dysfunction is associated with a 3.53-fold increased risk of cardiovascular events or death. This finding highlights the importance of developing easily applicable and consensual diagnostic criteria, as well as fostering research on effective treatment strategies when diastolic dysfunction is identified in the subclinical stage.     

Effective radiation dose of three diagnostic tests in cardiology: Single photon emission computed tomography,invasive coronary angiography and cardiac computed tomography angiography

IntroductionDiagnostic tests that use ionizing radiation play a central role in cardiology and their use has grown in recent years, leading to increasing concerns about their potential stochastic effects.The aims of this study were to compare the radiation dose of three diagnostic tests: single photon emission computed tomography (SPECT), invasive coronary angiography (ICA) and cardiac computed tomography (cardiac CT) and their evolution over time, and to assess the influence of body mass index on radiation dose.MethodsWe assessed consecutive patients included in three prospective registries (SPECT, ICA and cardiac CT) over a period of two years. Radiation dose was converted to mSv and compared between the three registries. Differences over time were evaluated by comparing the first with the fourth semester.ResultsA total of 6196 exams were evaluated: 35% SPECT, 53% ICA and 22% cardiac CT. Mean radiation dose was 10.7±1.2 mSv for SPECT, 8.1±6.4 mSv for ICA, and 5.4±3.8 mSv for cardiac CT (p<0.001 for all). With regard to the radiation dose over time, there was a very small reduction in SPECT (10.7 to 10.5 mSv, p=0.004), a significant increase (25%) in ICA (7.0 to 8.8 mSv; p<0.001), and a significant reduction (29%) in cardiac CT (6.5 to 4.6 mSv, p<0.001). Obesity was associated with a significantly higher radiation dose in all three exams.ConclusionsCardiac CT had a lower mean effective radiation dose than invasive coronary angiography, which in turn had a lower mean effective dose than SPECT.There was a significant increase in radiation doses in the ICA registry and a significant decrease in the cardiac CT registry over time.     

Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction

IntroductionStent restenosis remains a clinical challenge for patients with ischemic heart disease, since it is associated with repeated coronary interventions as well as higher hospitalization rates and medical costs. Inflammation plays a significant role. Although an association between stent restenosis, increased C-reactive protein (CRP) and decreased albumin levels has been previously reported, no studies have investigated the ability of the CRP/albumin ratio to predict stent restenosis.MethodsThis retrospective study included 448 patients who had previously undergone primary percutaneous coronary intervention and who were referred for subsequent reintervention due to recurrence of anginal symptoms. The study population was divided into two groups based on whether the patient had developed stent restenosis. They were then stratified into three groups according to their CRP/albumin ratio.ResultsOut of 448 patients, stent restenosis was observed in 24.5% (n=110), as determined by coronary angiography. Patients with stent restenosis had a higher CRP/albumin ratio, greater platelet distribution width (PDW), higher CRP levels, and lower levels of both high-density lipoprotein (HDL) cholesterol and serum albumin. The CRP/albumin ratio (OR: 2.289, 95% CI: 1.056-4.959; p=0.036), stent diameter, PDW and HDL cholesterol levels were found to be independent predictors of stent restenosis. A ROC curve comparison demonstrated that the CRP/albumin ratio was a better predictor of restenosis than either albumin and CRP individually, but it was not better than PDW and HDL cholesterol.ConclusionAs a novel inflammation-based risk score, the CRP/albumin ratio may be an easily accessible marker for assessment of stent restenosis risk.     

应激性高血糖对急诊PCI患者心肌灌注及临床预后的影响

目的探讨应激性高血糖(SHG)对接受直接经皮冠状动脉介入治疗(PCI)急性ST段抬高心肌梗死(STEMI)患者心肌灌注及临床预后的影响。方法纳入初次发生STEMI并在起病12 h内行直接PCI治疗的非糖尿病患者352例,按入院即刻血糖(SG)水平分为三组:正常血糖组(SG7.0 mmol/L)114例;血糖升高组(7.0 mmol/L≤SG≤11.1 mmol/L)128例;高血糖(SHG)组(SG11.1 mmol/L)110例。比较三组患者直接PCI后心肌灌注指标包括术后2 h ST段回落(STR),TIMI心肌灌注分级(TMPG)及心肌肌酸激酶同工酶(CK-MB)峰值、术后左室射血分数(LVEF)的差异。PCI后随访12个月,观察并记录三组患者随访期内心脏不良事件(MACEs)的发生情况。结果正常血糖组、血糖升高组、SHG组三组患者随血糖水平升高,术后2h STR良好比例(71.9%vs.53.9%vs.44.5%)及TMPG2-3级比例(70.2%vs.54.7%vs.46.4%),均逐渐降低(P均0.05),术后CK-MB峰值逐渐升高(189.2±78.9mmol/L vs.214.6±80.1mmol/L vs.246.5±79.2mmol/L,P0.01)且术后7~10天LVEF明显降低,以高血糖组降低最明显[(52.7±7.2)%vs.(50.8±6.7)%vs.(49.1±5.5)%,P0.01]。PCI后随访12个月,Kaplan-Meier生存分析发现三组患者累积无MACEs事件生存率差异有统计学意义(89.5%vs.85.9%vs.77.3%,Logrank=7.173,P=0.028),在校正了年龄后,多因素Cox回归分析显示SHG是STEMI患者直接PCI术后MACEs发生的独立预测因子。SHG组患者较正常血糖组患者术后发生MACEs的风险增加3.546倍(RR=3.546,P0.01)。结论 STEMI患者并发SHG会导致直接PCI再灌注治疗后心肌灌注水平降低,致使心脏不良事件发生率升高,影响患者的临床预后。