南方医科大学学报

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (12): 2767-2776.doi: 10.12122/j.issn.1673-4254.2025.12.24

• • 上一篇    

冠状动脉微血管功能障碍的评估及其对ST段抬高型急性心肌梗死再灌注治疗的预测价值：基于QFR-AMR研究

高世毅1(), 韩子晨2,4(), 曾强1, 程增为3, 王钧1, 康品方1, 王洪巨1, 李妙男1(), 胡司淦1()   

  1. 1.蚌埠医科大学第一附属医院心血管内科，安徽 蚌埠 233004
    2.宿州市第一人民医院心血管内科，安徽 宿州 234099
    3.五河县人民医院心血管内科，安徽 蚌埠 233300
    4.蚌埠医科大学研究生院，安徽 蚌埠 233030
  • 收稿日期:2025-06-22 出版日期:2025-12-20 发布日期:2025-12-22
  • 通讯作者: 李妙男,胡司淦 E-mail:1933799781@qq.com;291979024@qq.com;13855265385@163.com;siganhu@126.com
  • 作者简介:高世毅，在读硕士研究生，E-mail: 1933799781@qq.com
    韩子晨，硕士，E-mail: 291979024@qq.com
    第一联系人：高世毅、韩子晨共同为第一作者
  • 基金资助:
    安徽省临床科研转化项目(202304295107020086)

Evaluation of coronary microvascular dysfunction for assessing prognosis of ST-segment elevation acute myocardial infarction following reperfusion therapy: insights from QFR-AMR

Shiyi GAO1(), Zichen HAN2,4(), Qiang ZENG1, Zengwei CHENG3, Jun WANG1, Pinfang KANG1, Hongju WANG1, Miaonan LI1(), Sigan HU1()   

  1. 1.Department of Cardiology, First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, China
    2.Department of Cardiology, Suzhou First People's Hospital, Suzhou 234009, China
    3.Department of Cardiology, Wuhe County People's Hospital, Bengbu 233300, China
    4.Graduate School, Bengbu Medical University, Bengbu 233030, China
  • Received:2025-06-22 Online:2025-12-20 Published:2025-12-22
  • Contact: Miaonan LI, Sigan HU E-mail:1933799781@qq.com;291979024@qq.com;13855265385@163.com;siganhu@126.com

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摘要：

目的 通过联合评估冠状动脉大血管和微循环，全面预测ST段抬高型心肌梗死（STEMI）患者接受经皮冠状动脉介入治疗（PCI）治疗后发生不良心脑血管事件（MACCEs） 的风险。 方法 回顾性纳入来自两个医学中心的507例成功接受PCI的STEMI患者。基于受试者工作特征（ROC）曲线分析，确定基于血管的微血管阻力（AMR）预测MACCEs的最佳截断值为256.5 mmHg·s/m，结合既往文献确立的定量流量比（QFR）临界值0.80，采用2×2析因设计将患者分为4个亚组。第1组为心外膜血管功能正常且微循环功能良好组（QFR≥0.8且AMR<256.5，n=271，占53.5%）；第2组为心外膜血管功能正常但微循环功能异常组（QFR≥0.8且AMR≥256.5，n=140，占27.6%）；第3组为心外膜血管功能异常但微循环功能相对良好组（QFR<0.8且AMR<256.5，n=77，占15.2%）；第4组为心外膜血管与微循环功能均异常组（QFR<0.8且AMR≥256.5，n=19，占3.7%）。主要临床结局为2年随访期间的心源性死亡或因心力衰竭再次入院的发生情况。 结果 在507例患者中，AMR≥256.5 mmHg·s/m的患者在PCI术后2年内发生MACCEs 的风险显著增加（P<0.001）。Kaplan-Meier生存分析表明，QFR<0.8且AMR≥256.5 mmHg·s/m的患者具有更差的生存率。多元线性回归分析显示，糖尿病（P<0.001）、高脂血症（P<0.001）、吸烟 （P<0.014）、系统性炎症反应指数（P<0.007）以及血小板与淋巴细胞比值（P<0.001）均与AMR水平升高独立相关。此外，限制性立方样条回归分析揭示了AMR与MACCEs发生风险之间的非线性关系（non-linear P<0.001），当AMR阈值达到259.45 mmHg·s/m时，MACCEs的发生风险显著增加。 结论 基于QFR与AMR的联合评估框架可有效预测STEMI患者急诊PCI术后发生MACCEs的风险。此外，AMR是PCI术后MACCEs的独立预测指标，其数值升高与MACCEs风险显著相关。

关键词: 冠状动脉微循环障碍, 基于血管的微血管阻力, 定量血流比, 急性ST段抬高型心肌梗死, 主要不良心脑血管事件

Abstract:

Objective To assess the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with ST-segment elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI) by evaluating both the large coronary vessels and coronary microcirculation. Methods A total of 507 patients with STEMI undergoing successful percutaneous coronary intervention (PCI) were retrospectively enrolled from two centers. The optimal cut-off value (256.5 mmHg·s·m-1) of angio-based microvascular resistance (AMR) for predicting MACCEs was determined by ROC analysis. Combined with a quantitative flow ratio (QFR) threshold of 0.80, the patients were classified into 4 groups: Group 1 (QFR≥0.8, AMR<256.5; n=271), Group 2 (QFR≥0.8, AMR≥256.5; n=140), Group 3 (QFR<0.8, AMR<256.5; n=77), and Group 4 (QFR<0.8, AMR≥256.5; n=19). The primary endpoint was cardiac death or heart failure readmission within 2 years. Results Patients with elevated AMR (≥256.5 mmHg·s·m-1) had a significantly increased risk of MACCEs within two years after PCI (P<0.001). Kaplan-Meier analysis showed the lowest survival rate in patients with both QFR<0.8 and AMR≥256.5 mmHg·s·m-1. Multiple linear regression analysis suggested that diabetes (P<0.001), hyperlipidemia (P<0.001), smoking (P<0.014), systemic inflammation response index (P<0.007), and platelet to lymphocyte ratio (P<0.001) were independently associated with elevated AMR levels. Restricted cubic spline regression revealed a non-linear relationship between AMR and MACCEs risk (non-linear P<0.001), and the hazard ratio for MACCEs increased markedly for an AMR beyond the threshold of 259.45 mmHg·s·m-1. Conclusion The integrated assessment of QFR and AMR allows effective prediction of MACCEs risk in STEMI patients after PCI, and elevated AMR is an independent predictor of significantly increased risk of MACCEs.

Key words: coronary microcirculatory dysfunction, angio-based microvascular resistance, quantitative flow ratio, st-segment elevation myocardial infarction, major adverse cardiovascular and cerebrovascular events