背景:ST段抬高型心肌梗死(STEMI)后的最终梗死面积(IS)是死亡率的主要预测指标。寻找最终IS的早期预测因子可以指导那些公认的高风险患者的个性化治疗策略。
结果:80例成功接受经皮冠状动脉介入治疗(pPCI)的STEMI患者接受了基线(48h内)2D,3D超声心动图与斑点追踪,然后在3个月时进行心脏磁共振(CMR)以评估最终IS。招聘后,4名患者因无法控制的幽闭恐惧症而被排除在外,而76名患者完成了最终分析。平均±标准差年龄为54.1±10.9岁,84%是男性,25%有糖尿病,26%是高血压患者,71%是目前的吸烟者,82%有血脂异常,18%有早发冠状动脉疾病家族史.到3个月,进行CMR以准确评估最终IS。在单变量回归分析中,入院心率,基线和pPCI术后ST段抬高,STEMI位置(前部与劣等),围手术期肌钙蛋白最高,血栓负荷大,心肌梗死血流分级的基线溶栓,最终的心肌腮红等级,2D和3D左心室射血分数(LVEF),二维和三维整体纵向应变(GLS)参数是最终IS的重要预测因子。在多元回归分析中,构建了四个模型,并识别了PCI术后残余ST段抬高,围手术期肌钙蛋白最高,2D-LVEF,3D-LVEF,和2D-GLS作为最终IS的重要独立预测因子。
结论:在成功接受pPCI的STEMI患者中,最终IS的早期预测因素对于指导治疗决策至关重要。pPCI术后残余ST段抬高,围手术期肌钙蛋白最高,和基线2D-LVEF,3D-LVEF,2D-GLS可以是预测最终IS的优秀和及时的工具。
BACKGROUND: Final infarct size (IS) after ST segment elevation myocardial infarction (STEMI) is a major predictor of mortality. Seeking early predictors for final IS can guide individualized therapeutic strategies for those recognized to be at higher risk.
RESULTS: Eighty STEMI patients successfully treated with primary percutaneous coronary intervention (pPCI) underwent baseline (within 48 h) 2D, 3D echocardiography with speckle tracking and then underwent cardiac magnetic resonance (CMR) at 3 months to assess the final IS. After recruitment, 4 patients were excluded for uncontainable claustrophobia while 76 patients completed the final analysis. The mean ± standard deviation age was 54.1 ± 10.9 years, 84% were males, 25% had diabetes, 26% were hypertensives, 71% were current smokers, 82% had dyslipidemia, and 18% had a family history of premature coronary artery disease. By 3 months, CMR was performed to accurately evaluate the final IS. In univariate regression analysis, the admission heart rate, baseline and post-pPCI ST elevation, STEMI location (anterior vs. inferior), highest peri-procedural troponin, large thrombus burden, baseline thrombolysis in myocardial infarction flow grade, the final myocardial blush grade, the 2D and 3D left ventricular ejection fraction (LVEF), and the 2D and 3D global longitudinal strain (GLS) parameters were significant predictors for the final IS. In the multivariate regression analysis, four models were constructed and recognized the residual post-PCI ST segment elevation, the highest peri-procedural troponin, the 2D-LVEF, 3D-LVEF, and 2D-GLS as significant independent predictors for final IS.
CONCLUSIONS: In STEMI patients who underwent successful pPCI, early predictors for the final IS are vital to guide therapeutic decisions. The residual post-pPCI ST elevation, the highest peri-procedural troponin, and the baseline 2D-LVEF, 3D-LVEF, and 2D-GLS can be excellent and timely tools to predict the final IS.