急性st段抬高型心肌梗死患者经皮冠状动脉介入治疗后的预后

M. Sokolov
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引用次数: 0

摘要

心肌梗塞每年夺去地球上数百万人的生命。缺血性心脏损伤在工作年龄的年轻人中发病率越来越高,造成了严重的医疗和社会问题。经皮冠状动脉介入治疗(PCI)是st段抬高型心肌梗死(STEMI)的主要治疗方法。本研究的目的是优化急性STEMI在初次PCI术后的预后。材料和方法。该研究纳入了98例接受初级PCI治疗的STEMI患者。作为血运重建术的一部分,每位患者都进行了手动血栓抽吸。获得的血栓物质的体积足以进行组织学分析,并进行进一步的宏观和显微镜检查。预后评估主要冠状动脉事件发生的概率,如死亡、心肌梗死、反复血运重建术或心绞痛再现。为了挑出的因素,当组合时,对预后有可靠的影响,一步一步的逻辑回归与正向选择的方法被使用。为了评估所获得模型的合理性水平,进行了伪r平方Nagelkerkes分析,这是线性回归的r平方模拟。结果。2年随访期间,34例(34.69%)患者发生重大冠状动脉事件。对获得的数据进行分析后,分离出血栓的四个特征,这些特征结合起来对终点的发展有影响。这些是旧血栓,存在微通道,炎症浸润和宏观混合血栓。计算公式为:Z = 0.5•V2 - 0.04•V1 - 0.1•V3 + 1.77•V4 - 1.51,其中V1 =旧血栓,V2 =微通道存在,V3 =炎症浸润,V4 =宏观混合血栓。结论。通过分析冠状动脉内血栓的形态特征,可以评估STEMI患者的长期预后。收稿日期:28.11.2022
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognosis in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary interventions
Myocardial infarction claims million lives on the planet each year. Ischemic heart injury is diagnosed with increasing incidence among younger people of working age, posing significant medical and social problem. Percutaneous coronary interventions (PCI) are the primary treatment for ST-segment elevation myocardial infarction (STEMI). The aim of the study was to optimize the prognosis of acute STEMI after primary PCI. Materials and methods. The study included 98 patients with STEMI who were undergoing primary PCI. As a part of revascularization procedure, a manual thromboaspiration was performed for each patient. Thrombotic material was obtained at a volume sufficient for histological analysis with further macro- and microscopic examination. Prognosis was assessed by the probability of occurrence of major coronary events, such as death, myocardial infarction, repeated revascularization or reappearance of angina. In order to single out the factors that, when combined, have a reliable influence on the prognosis, a step-by-step method of logistic regression with forward selection was used. To assess the level of plausibility of the obtained model, a pseudo R-square Nagelkerkes analysis, an analogue of R-square for linear regression, was performed. The results. During two years of follow-up, major coronary events occurred in 34 patients (34.69%). After analysis of the obtained data, four characteristics of thrombi were separated, which, when combined, had an impact on the development of the end-point. These were old thrombi, the presence of microchannels, inflammatory infiltration, and macroscopically mixed thrombi. The resulting formula was as follows: Z = 0.5•V2 – 0.04•V1 – 0.1•V3 + 1.77•V4 – 1.51, where V1 = old thrombus, V2 = presence of microchannels, V3 = inflammatory infiltration, V4 = macroscopically mixed thrombus. Conclusions. Analysis of the morphological characteristics of intracoronary thrombi allowed assessing the long-term prognosis in patients with STEMI. Article received: 28.11.2022
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