【摘要】 目的:探讨应用冠状动脉(冠脉)造影衍生的微循环阻力指数(Angio-IMR,AMR)预测急性心肌梗死(AMI)行直接经皮冠脉介入(PCI)治疗患者的冠脉微循环功能及临床预后的价值。方法:回顾性收集济宁市第一人民医院急诊科2022年1月1日—2024年12月31日收治的行直接PCI的144例AMI患者的临床资料。根据AMR,将患者分为微循环功能障碍组(AMR>2.5 mmHg·s/m, CMD组，63例)和非微循环功能障碍组(AMR≤2.5 mmHg·s/m,非CMD组，81例),比较两组临床特征及预后。结果:CMD组年龄、血管定量血流分数(QFR)、狭窄>90%血管支数、硝普钠剂量、住院天数及院内病死率均高于非CMD组(均P<0.05),体重、血流速度、红细胞及血红蛋白水平、平均血小板体积、血小板平均宽度、大型血小板比率均低于非CMD组(均P<0.05)。CMD组住院平均天数和院内病死率高于非CMD组(均P<0.05)。结论:AMI患者PCI血运重建后CMD发生率高。AMR受年龄、冠脉狭窄支数、血管QFR及血流速度影响，高AMR增加AMI患者住院天数及院内死亡风险。更多还原

【Abstract】 Objective: To investigate the value of angiography-derived microcirculatory resistance index(Angio-IMR, AMR) in predicting coronary microcirculatory function and clinical outcomes in patients with acute myocardial infarction(AMI) who are undergoing primary percutaneous coronary intervention(PCI). Methods: Clinical data from 144 AMI patients who underwent primary PCI at the Emergency Department of Jining First People’s Hospital from January 1, 2022, to December 31, 2024, were retrospectively collected. Patients were divided into two groups based on AMR: the microcirculatory dysfunction group(AMR>2.5 mmHg·s/cm, CMD group, n=63) and the non-microcirculatory dysfunction group(AMR ≤ 2.5 mmHg·s/cm, non-CMD group, n=81). Clinical characteristics and outcomes were compared between the two groups. Results: The CMD group had higher age, quantitative flow ratio(QFR), number of vessels with>90% stenosis, nitroprusside dosage, length of hospital stay, and in-hospital mortality compared to the non-CMD group(all P<0.05). In contrast, body weight, blood flow velocity, red blood cell and hemoglobin levels, mean platelet volume, mean platelet width, and large platelet ratio were lower in the CMD group(all P<0.05). The average length of hospital stay and in-hospital mortality were significantly higher in the CMD group(both P<0.05). Conclusion: The incidence of CMD after PCI revascularization is high in AMI patients. AMR is influenced by age, number of stenosed coronary vessels, QFR, and blood flow velocity. High AMR increases the length of hospital stay and the risk of in-hospital mortality in AMI patients.更多还原