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Circ Cardiovasc Imaging:识别ST段抬高型心肌梗死后的高风险病人:血管造影术和心脏磁共振之间的比较

2017-06-13 fengxiangxin MedSci原创

经皮冠状动脉介入治疗急性ST段抬高的心肌梗死之后,血管造影术中无再流(NR)的发生和心脏磁共振下微血管阻塞(MVO)的发生存在明显不同步现象。最近,影响放射领域顶级期刊Circ Cardiovasc Imaging上发表了一项关于此现象的研究。研究的目的是探讨在一组连续入院的首次行急诊经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死患者中,NR和MVO的发生有何特点。

经皮冠状动脉介入治疗急性ST段抬高的心肌梗死之后,血管造影术中无再流(NR)的发生和心脏磁共振下微血管阻塞(MVO)的发生存在明显不同步现象。最近,影像放射领域顶级期刊Circ Cardiovasc Imaging上发表了一项关于此现象的研究。研究的目的是探讨在一组连续入院的首次行急诊经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死患者中,NR和MVO的发生有何特点。

88位连续入院的 ST段抬高型心肌梗死患者在症状发作后12小时以内入选此项前瞻性研究中(从连续入院的248位患者中通过控制年龄、BMI、疾病史、慢性肾衰程度等条件筛选出的88 位)。所有患者在初次急诊经皮冠状动脉介入治疗(PCI)后2至5天接受心脏磁共振检查。NR被定义为心肌梗死溶栓治疗血流分级≤2和心肌呈色分级<2。分别在钆剂注射4分钟和10-15分钟评估微血管堵塞情况。

影像证据表明,31例患者(36%)有NR,58(67%)例患者有MVO。除其中一例有NR的患者没有MVO之外,其余30例有NR患者同时有MVO。有MVO的患者有较高的肌钙蛋白T峰(P<0.0001),较大的延迟钆剂增强区(P<0.0001)和因心收缩末期容积增加(P = 0.015)而降低的左室射血分数(P<0.001)。相反,有NR的患者有较高的肌钙蛋白T峰值(P = 0.006),却有和那些无NR的患者类似的延迟钆剂增强区(P = 0.24)。那些有MVO患者的PCI治疗后无主要不良心血管事件发生率较低(P = 0.014),但是在有NR和没有NR的患者中无主要不良心血管事件发生率相似(P = 0.33)。主要不良心血管事件的独立预测因子为MVO(危险比: 3.418;P = 0.046)和缺血时间(危险比:1.016;P<0.001)。MVO是预测靶病变血管血运重建发生的强烈预测因子(P = 0.017,log-rank 检验)。

首次行经皮冠状动脉介入治疗后的ST段抬高型心肌梗死患者在住院期间,与在病变动脉再通后行冠状动脉血管造影术相比,心脏磁共振可提供更好的预后分层分析。另一个新的研究发现是,在有MVO的患者中,最终需要行临床驱动的靶病变再次血运重建的概率更高。

原始出处:

Durante, A., A. Laricchia, G. Benedetti, et al., Identification of High-Risk Patients After ST-Segment-Elevation Myocardial Infarction: Comparison Between Angiographic and Magnetic Resonance Parameters. Circ Cardiovasc Imaging, 2017. 10(6): p. e005841.

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  4. 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topicName=ST段)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=676820671866, createdName=hyf035, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210268, encodeId=b1ea2102686f, content=心脏磁共振作用不容小觑, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRr63iayTjay9otQ2yDAmbravgszHBxSLHIJpTZ8uNAiaa87bfqeDpEPTUicdBhBlf5yABuAj1OwClO4/0, createdBy=c3622063904, createdName=fengxiangxin301, createdTime=Tue Jun 13 16:30:56 CST 2017, time=2017-06-13, status=1, ipAttribution=)]
    2018-03-17 yzh399
  5. 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  6. 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  7. 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createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Wed Sep 13 18:44:00 CST 2017, time=2017-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1862016, encodeId=4112186201621, content=<a href='/topic/show?id=a374102813a1' target=_blank style='color:#2F92EE;'>#高风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102813, encryptionId=a374102813a1, topicName=高风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f5e185, createdName=zlawrance, createdTime=Sun Mar 18 01:44:00 CST 2018, time=2018-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1814293, encodeId=68e21814293e2, content=<a href='/topic/show?id=54149498e79' target=_blank style='color:#2F92EE;'>#造影术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94987, encryptionId=54149498e79, topicName=造影术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=310e209, createdName=yzh399, createdTime=Sat Mar 17 22:44:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1341564, encodeId=385c134156410, content=<a href='/topic/show?id=24b8e37529a' target=_blank style='color:#2F92EE;'>#磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73752, encryptionId=24b8e37529a, topicName=磁共振)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=24a22500182, createdName=1696533704_45270454, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401450, encodeId=195914014503f, content=<a href='/topic/show?id=c818516291b' target=_blank style='color:#2F92EE;'>#心脏磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51629, encryptionId=c818516291b, topicName=心脏磁共振)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3f342339746, createdName=mhzhuang@stu.e, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423026, encodeId=0ffe142302680, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1494032, encodeId=ba991494032b9, content=<a href='/topic/show?id=3e34949e333' target=_blank style='color:#2F92EE;'>#造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94973, encryptionId=3e34949e333, topicName=造影)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=908d9134595, createdName=sodoo, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1624350, encodeId=66f0162435046, content=<a href='/topic/show?id=f27b16862d9' target=_blank style='color:#2F92EE;'>#ST段#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16862, encryptionId=f27b16862d9, topicName=ST段)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=676820671866, createdName=hyf035, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210268, encodeId=b1ea2102686f, content=心脏磁共振作用不容小觑, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRr63iayTjay9otQ2yDAmbravgszHBxSLHIJpTZ8uNAiaa87bfqeDpEPTUicdBhBlf5yABuAj1OwClO4/0, createdBy=c3622063904, createdName=fengxiangxin301, createdTime=Tue Jun 13 16:30:56 CST 2017, time=2017-06-13, status=1, ipAttribution=)]
    2017-06-15 gdsun
  8. [GetPortalCommentsPageByObjectIdResponse(id=1938717, encodeId=47bf1938e17a8, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon Dec 11 01:44:00 CST 2017, time=2017-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812518, encodeId=dc4f181251886, content=<a href='/topic/show?id=f89a89e94e9' target=_blank style='color:#2F92EE;'>#血管造影术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89794, encryptionId=f89a89e94e9, topicName=血管造影术)], attachment=null, authenticateStatus=null, 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objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94987, encryptionId=54149498e79, topicName=造影术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=310e209, createdName=yzh399, createdTime=Sat Mar 17 22:44:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1341564, encodeId=385c134156410, content=<a href='/topic/show?id=24b8e37529a' target=_blank style='color:#2F92EE;'>#磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73752, encryptionId=24b8e37529a, topicName=磁共振)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=24a22500182, createdName=1696533704_45270454, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401450, encodeId=195914014503f, content=<a href='/topic/show?id=c818516291b' target=_blank style='color:#2F92EE;'>#心脏磁共振#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51629, encryptionId=c818516291b, topicName=心脏磁共振)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3f342339746, createdName=mhzhuang@stu.e, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423026, encodeId=0ffe142302680, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, 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topicName=ST段)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=676820671866, createdName=hyf035, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210268, encodeId=b1ea2102686f, content=心脏磁共振作用不容小觑, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRr63iayTjay9otQ2yDAmbravgszHBxSLHIJpTZ8uNAiaa87bfqeDpEPTUicdBhBlf5yABuAj1OwClO4/0, createdBy=c3622063904, createdName=fengxiangxin301, createdTime=Tue Jun 13 16:30:56 CST 2017, time=2017-06-13, status=1, ipAttribution=)]
    2017-06-15 sodoo
  9. [GetPortalCommentsPageByObjectIdResponse(id=1938717, encodeId=47bf1938e17a8, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon Dec 11 01:44:00 CST 2017, time=2017-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1812518, encodeId=dc4f181251886, content=<a href='/topic/show?id=f89a89e94e9' target=_blank style='color:#2F92EE;'>#血管造影术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89794, encryptionId=f89a89e94e9, topicName=血管造影术)], attachment=null, authenticateStatus=null, 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topicName=ST段)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=676820671866, createdName=hyf035, createdTime=Thu Jun 15 01:44:00 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210268, encodeId=b1ea2102686f, content=心脏磁共振作用不容小觑, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRr63iayTjay9otQ2yDAmbravgszHBxSLHIJpTZ8uNAiaa87bfqeDpEPTUicdBhBlf5yABuAj1OwClO4/0, createdBy=c3622063904, createdName=fengxiangxin301, createdTime=Tue Jun 13 16:30:56 CST 2017, time=2017-06-13, status=1, ipAttribution=)]
    2017-06-15 hyf035
  10. 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    2017-06-13 fengxiangxin301

    心脏磁共振作用不容小觑

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