Objective: To evaluate the feasibility of detecting index of microcirculatory resistance (IMR) and the relationship between IMR and left ventricular (LV) systolic function after acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods: The patients with first AMI received primary PCI in Peking University Third Hospital were enrolled from January 2014 to March 2016. IMR were measured immediately after PCI by using pressure/temperature wire. The relationship between IMR and left ventricular ejection fraction (LVEF) assessed by echocardiography at first day and 6 months after admission was evaluated. Results: Twenty-eight patients with anterior wall AMI were enrolled, with an average age (56±13) years. The success rate of IMR detection was 100%. The mean IMR was (33±18 )mmHg·s. There was no complication related to intravenous adenosine triphosphate (ATP) (140 μg· kg(-1)· min(-1)). The IMR was negatively correlated with TIMI blood flow grade after primary PCI (r=-0.386, P=0.043), and positively correlated with female gender, CK peak value and TnT peak value (r=0.430, P=0.022; r=0.431, P=0.025; r=0.434, P=0.024). After 6 months of follow-up, no adverse cardiovascular events (including cardiac death, nonfatal myocardial infarction, malignant arrhythmia, unplanned revascularization, hospitalization for unstable angina pectoris and severe heart failure requiring hospitalization) occurred. LVEF increased significantly compared with the first day after PCI (0.54±0.08 vs 0.47±0.06, P=0.001), and IMR was negatively correlated with LVEF after 6 months (r=-0.477, P=0.014). Multivariable linear regression analysis showed that CK peak and IMR were predictors of LVEF after six months ( β=-0.595, t=-3.814, P=0.01; β=-0.352, t=-2.26, P=0.036). Conclusions: Immediate detection of IMR in patients with anterior wall AMI after PCI is safe and feasible. The immediate IMR after PCI reflects the extent of myocardial necrosis and myocardial perfusion, and is a predictor of LVEF at 6 months after PCI.
目的： 探讨急性心肌梗死(AMI)直接经皮冠状动脉介入治疗(PCI)患者微循环阻力指数(IMR)检测的可行性，以及评价术后即刻梗死区域心肌的IMR与左心室收缩功能的关系。 方法： 入选2014年1月至2016年3月在北京大学第三医院住院的首次AMI并接受直接PCI治疗的患者。PCI术后即刻通过压力/温度导丝测定梗死相关血管的IMR，并评价IMR与住院第1天和术后6个月超声心动图左心室射血分数(LVEF)的关系。 结果： 28例前壁AMI患者入选，平均年龄(56±13)岁。IMR检测的成功率为100%，平均IMR值为(33±18) mmHg·s，未见静脉ATP(140 μg·kg(－1)·min(－1))相关的并发症。相关分析显示IMR与女性、CK和TnT峰值呈正相关(r＝0.430，P＝0.022；r＝0.431，P＝0.025；r＝0.434，P＝0.024)，与PCI术后靶血管TIMI血流分级呈负相关(r＝－0.386，P＝0.043)。随访6个月，未发生心血管不良事件(包括心源性死亡、非致死性心肌梗死、恶性心律失常、非计划再次血管重建、不稳定性心绞痛需住院治疗和严重心力衰竭需住院治疗)。LVEF较术后第1天明显增加(0.54±0.08比0.47±0.06，P＝0.001)；IMR与6个月后的LVEF呈负相关(r＝－0.477，P＝0.014)。多元线性回归分析显示，CK峰值及IMR是6个月后LVEF值的预测因素(β＝－0.595，t＝－3.814，P＝0.01；β＝－0.352，t＝－2.26，P＝0.036)。 结论： 前壁AMI患者直接PCI术后即刻检测IMR安全、可行。PCI术后即刻的IMR反映了心肌坏死程度和心肌灌注水平，是PCI术后6个月LVEF的预测因子。.
Keywords: Acute myocardial infarction; Left ventricular function; Microcirculation; Percutaneous coronary intervention.