基于血管造影测量的微循环阻力可预测ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗后的左室射血分数下降
YE Jing-guang1
WANG Jia-jie2
LUO De-mou2
LIU Jie-liang1
ZHANG Ying1
DONG Hao-jian2
1.Department of Cardiovascular Function Diagnosis,Guangdong Provincial People's Hospital,Guangdong Academy of Medi-cal Sciences,Southern Medical University,Guangzhou,Guangdong 510080,China2.Department of Cardiovascular Medicine,Guang-dong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou,Guangdong 510080,China
摘要：Background Coronary microvascular dysfunction(CMD)is a critical pathological mechanism underlying left ventricular ejection fraction(LVEF)decline after primary percutaneous coronary intervention(PPCI)in ST-seg-ment elevation myocardial infarction(STEMI)patients.Angiography-derived microcirculatory resistance(AMR),a novel wire-free index,offers noninvasive assessment of CMD.This study aimed to validate AMR's predictive val-ue for post-PPCI LVEF impairment.Methods A total of 190 STEMI patients who underwent PPCI at four centers between March 2017 and May 2022 were retrospectively enrolled.Patients were categorized into two groups based on whether their LVEF was below 50%when measured after 72 hours post-PPCI:the normal LVEF group(n=114)and the reduced LVEF group(n=76).The clinical characteristics of the two groups were compared.AMR was com-puted using quantitative flow ratio(QFR)analysis.Multivariable logistic regression,linear regression,and receiver operating characteristic(ROC)curves were applied to assess predictive performance.Results The reduced LVEF group exhibited significantly higher post-PPCI AMR(268 mmHg·s/m vs.229 mmHg·s/m,P<0.001)compared to the normal LVEF group.Multivariable logistic and linear regression confirmed that elevated AMR(OR:1.01;95%CI:1.00-1.02,P=0.001)was an independent predictor of LVEF decline to<50%after PPCI.ROC analysis revealed a moderate predictive capacity of AMR,with an area under the curve(AUC)of 0.684(95%CI:0.608-0.760).The optimal AMR cutoff of 262.5 mmHg·s/m demonstrated 55.26%sensitivity and 72.81%specificity for identifying LVEF decline in reperfused STEMI patients.Conclusions Post-PPCI AMR was an independent predictor of LVEF decline to<50%in STEMI patients.The data demonstrated that an AMR threshold of≥262.5 mmHg·s/m af-ter PPCI was associated with a statistically significant increase in the likelihood of LVEF reduction compared to in-dividuals with AMR values within the normal range.[S Chin J Cardiol 2025;26(4):207-218]
机标关键词：直接经皮冠状动脉介入治疗st段抬高型心肌梗死心肌梗死患者左室射血分数下降血管造影介入治疗后微循环阻力可预测
论文发表日期：2025-12-30
在线出版日期：2026-01-27（本平台首次上网日期，不代表文献的发表时间）
页数：13( 207-218,258 )
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