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Article(id=1208154039762661731, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208154038609228128, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2022.02.0171, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1636300800000, receivedDateStr=2021-11-08, revisedDate=null, revisedDateStr=null, acceptedDate=1639497600000, acceptedDateStr=2021-12-15, onlineDate=1765975969495, onlineDateStr=2025-12-17, pubDate=1645977600000, pubDateStr=2022-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1765975969495, onlineIssueDateStr=2025-12-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1765975969495, creator=13701087609, updateTime=1765975969495, updator=13701087609, issue=Issue{id=1208154038609228128, tenantId=1146029695717560320, journalId=1189873630562394117, year='2022', volume='47', issue='2', pageStart='107', pageEnd='212', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1765975969218, creator=13701087609, updateTime=1765976148463, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1208154790459192257, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208154038609228128, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1208154790459192258, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208154038609228128, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=171, endPage=177, ext={EN=ArticleExt(id=1208154040345669991, articleId=1208154039762661731, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Related factors of intramyocardial hemorrhage in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To evaluate the predictors of the occurrence of intramyocardial hemorrhage (IMH) in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention. Methods A total of two hundred and four patients, admitted in the First Medical Center of Chinese PLA General Hospital from February, 2014 to March, 2019, diagnosed as STEMI undergoing emergency PCI treatment within the first 12 h of evolution, were screened for our retrospective analysis. IMH lesions were visualized by T2-weighted sequences on cardiac magnetic resonance (CMR) between days 3 to 7 after PCI. Based on the existence of IMH, all patients were classified into the non-IMH group (n=117) and the IMH group (n=87). We investigate the clinical features between the two groups. Factors influencing were analyzed by logistic regression analysis. Results Compared with the non-IMH group, the ischemia time, admission glucose, admission heart rate, hemoglobin(Hb) reduction, creatine kinase isoenzymes (CK-MB) peak value, troponin T (TnT) peak value, low-density lipoprotein cholesterol, infarct size were significantly higher and the left ventricular ejection fraction (LVEF) was significantly lower in IMH group(P<0.05). Besides, in the IMH group, the proportion of patients with diabetes mellitus history, hyperlipemia history, preprocedural thrombolysis in myocardial infarction (TIMI) flow grades <3, anterior infarction, periprocedural glycoprotein Ⅱb/Ⅲa inhibitor treatment was significantly higher (P<0.05). Logistic regression model presented that diabetes mellitus history (P=0.003, OR=7.782,95%CI 2.009-30.846), ischemia time (P<0.001, OR=1.011, 95%CI 1.007-1.014), admission glucose (P<0.001, OR=1.428, 95%CI 1.182-1.725), admission heart rate (P=0.006, OR=1.041, 95%CI 1.012-1.071), Hb reduction (P<0.001, OR=1.117, 95%CI 1.059-1.178), CK-MB peak value (P=0.007, OR=1.006, 95%CI 1.002-1.010), anterior infarction (P=0.042, OR=2.626, 95%CI 1.037-6.652) and periprocedural glycoprotein Ⅱb/Ⅲa inhibitor treatment (P=0.022, OR=3.362, 95%CI 1.195-9.460) were independent risk factors for IMH in acute STEMI patients undergoing PCI. Conclusion Diabetes mellitus history, ischemia time, admission glucose, admission heart rate, Hb reduction, CK-MB peak value, anterior infarction, periprocedural glycoprotein Ⅱb/Ⅲa inhibitor treatment were independent risk factors for IMH in the patients with acute STEMI undergoing primary PCI. Appropriate strategies for managing acute STEMI patients at high risk for IMH should be taken into consideration.

, correspAuthors=Geng Qian, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 探讨急性ST段抬高型心肌梗死(STEMI)直接PCI术后心肌内出血(IMH)的影响因素。方法 收集2014年2月－2019年3月在解放军总医院第一医学中心急诊行直接PCI治疗，且于术后3~7 d行心脏磁共振检查的204例急性STEMI患者的临床资料进行回顾性分析。根据是否存在IMH分为IMH阳性组(n=87)与IMH阴性组(n=117)，分析两组患者临床特征的差异，并采用logistic回归分析IMH发生的影响因素。结果 与IMH阴性组比较，IMH阳性组缺血总时间、入院血糖、入院心率、血红蛋白下降值、肌酸激酶同工酶(CK-MB)峰值、肌钙蛋白T(TnT)峰值、低密度脂蛋白胆固醇、梗死程度等明显增高，左室射血分数(LVEF)明显降低，糖尿病史、高脂血症史、术前TIMI血流<3级、前壁梗死、使用GPⅡb/Ⅲa受体拮抗剂的患者比例高，差异均有统计学意义(P<0.05)。Logistic回归分析结果显示，糖尿病史(P=0.003，OR=7.782，95%CI 2.009~30.846)、缺血总时间(P<0.001，OR=1.011，95%CI 1.007~1.014)、入院血糖(P<0.001，OR=1.428，95%CI 1.182~1.725)、入院心率(P=0.006，OR=1.041，95%CI 1.012~1.071)、血红蛋白下降值(P<0.001，OR=1.117，95%CI 1.059~1.178)、CK-MB峰值(P=0.007，OR=1.006，95%CI 1.002~1.010)、前壁梗死(P=0.012，OR=3.359，95%CI 1.307~8.633)、使用GPⅡb/Ⅲa受体拮抗剂(P=0.022，OR=3.362，95%CI 1.195~9.460)是急性STEMI患者直接PCI术后发生IMH的独立危险因素。结论 糖尿病史、缺血总时间、入院血糖、入院心率、血红蛋白下降值、CK-MB峰值、前壁梗死、使用GPⅡb/Ⅲa受体拮抗剂等为急性STEMI直接PCI术后IMH的独立危险因素，可实施适当的策略予以干预。

, correspAuthors=钱赓, authorNote=null, correspAuthorsNote=
钱赓，E-mail：
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姜子超，硕士研究生，主要从事冠心病诊疗和心脏磁共振方面的临床研究

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姜子超，硕士研究生，主要从事冠心病诊疗和心脏磁共振方面的临床研究

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姜子超，硕士研究生，主要从事冠心病诊疗和心脏磁共振方面的临床研究

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journalId=1189873630562394117, articleId=1208154039762661731, language=CN, orderNo=2, keyword=心肌梗死), Keyword(id=1208154045592744532, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=CN, orderNo=3, keyword=经皮冠状动脉介入治疗), Keyword(id=1208154045680824920, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=CN, orderNo=4, keyword=心脏磁共振)], refs=[Reference(id=1208154046913950364, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2019, volume=5, issue=1, pageStart=39, pageEnd=null, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Vogel B, Claessen BE, Arnold SV, journalName=Nat Rev Dis Primers, refType=null, unstructuredReference=Vogel B, Claessen BE, Arnold SV, et al. 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Clinical policy: emergency department management of patients needing reperfusion therapy for acute ST-segment elevation myocardial infarction[J]. Ann Emerg Med, 2017, 70(5): 724-739., articleTitle=Clinical policy: emergency department management of patients needing reperfusion therapy for acute ST-segment elevation myocardial infarction, refAbstract=null), Reference(id=1208154047119471274, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2017, volume=70, issue=12, pageStart=1082, pageEnd=null, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=Ibánez B, James S, Agewall S, journalName=Rev Esp Cardiol (Engl Ed), refType=null, unstructuredReference=Ibánez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation[J]. Rev Esp Cardiol (Engl Ed), 2017, 70(12): 1082., articleTitle=2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation, refAbstract=null), Reference(id=1208154047186580143, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2020, volume=45, issue=4, pageStart=441, pageEnd=446, url=null, language=null, rfNumber=[4], rfOrder=3, authorNames=Cheng B, Gao LY, journalName=Med J Chin PLA, refType=null, unstructuredReference=Cheng B, Gao LY. Effect of early intervene in non-culprit vessels on the prognosis of patients with acute ST-segment elevation myocardial infarction presenting with multivessel disease[J]. Med J Chin PLA, 2020, 45(4): 441-446., articleTitle=Effect of early intervene in non-culprit vessels on the prognosis of patients with acute ST-segment elevation myocardial infarction presenting with multivessel disease, refAbstract=null), Reference(id=1208154047283049142, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2020, volume=45, issue=4, pageStart=441, pageEnd=446, url=null, language=null, rfNumber=[4], rfOrder=4, authorNames=成彪, 高凌云, journalName=解放军医学杂志, refType=null, unstructuredReference=[成彪, 高凌云. 早期干预非罪犯血管对急性ST段抬高型心肌梗死合并多支血管病变患者预后的影响[J]. 解放军医学杂志, 2020, 45(4): 441-446.], articleTitle=早期干预非罪犯血管对急性ST段抬高型心肌梗死合并多支血管病变患者预后的影响, refAbstract=null), Reference(id=1208154047358546621, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2021, volume=39, issue=2, pageStart=190, pageEnd=217, url=null, language=null, rfNumber=[5], rfOrder=5, authorNames=Gunata M, Parlakpinar H, journalName=Cell Biochem Funct, refType=null, unstructuredReference=Gunata M, Parlakpinar H. A review of myocardial ischaemia/reperfusion injury: Pathophysiology, experimental models, biomarkers, genetics and pharmacological treatment[J]. Cell Biochem Funct, 2021, 39(2): 190-217., articleTitle=A review of myocardial ischaemia/reperfusion injury: Pathophysiology, experimental models, biomarkers, genetics and pharmacological treatment, refAbstract=null), Reference(id=1208154047455015617, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2017, volume=2017, issue=null, pageStart=7018393, pageEnd=null, url=null, language=null, rfNumber=[6], rfOrder=6, authorNames=Neri M, Riezzo I, Pascale N, journalName=Mediators Inflamm, refType=null, unstructuredReference=Neri M, Riezzo I, Pascale N, et al. Ischemia/reperfusion injury following acute myocardial infarction: a critical issue for clinicians and forensic pathologists[J]. Mediators Inflamm, 2017, 2017: 7018393., articleTitle=Ischemia/reperfusion injury following acute myocardial infarction: a critical issue for clinicians and forensic pathologists, refAbstract=null), Reference(id=1208154047555678922, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2015, volume=65, issue=14, pageStart=1454, pageEnd=1471, url=null, language=null, rfNumber=[7], rfOrder=7, authorNames=Ibáñez B, Heusch G, Ovize M, journalName=J Am Coll Cardiol, refType=null, unstructuredReference=Ibáñez B, Heusch G, Ovize M, et al. Evolving therapies for myocardial ischemia/reperfusion injury[J]. J Am Coll Cardiol, 2015, 65(14): 1454-1471., articleTitle=Evolving therapies for myocardial ischemia/reperfusion injury, refAbstract=null), Reference(id=1208154047635370700, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2020, volume=45, issue=8, pageStart=857, pageEnd=861, url=null, language=null, rfNumber=[8], rfOrder=8, authorNames=Liu DY, Cao F, journalName=Med J Chin PLA, refType=null, unstructuredReference=Liu DY, Cao F. Advances in intramyocardial hemorrhage of perfused acute myocardial infarction by cardiovascular magnetic resonance[J]. Med J Chin PLA, 2020, 45(8): 857-861., articleTitle=Advances in intramyocardial hemorrhage of perfused acute myocardial infarction by cardiovascular magnetic resonance, refAbstract=null), Reference(id=1208154047727645388, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2020, volume=45, issue=8, pageStart=857, pageEnd=861, url=null, language=null, rfNumber=[8], rfOrder=9, authorNames=刘冬月, 曹丰, journalName=解放军医学杂志, refType=null, unstructuredReference=[刘冬月, 曹丰. 磁共振评估心肌梗死再灌注后心肌内出血的研究进展[J]. 解放军医学杂志, 2020, 45(8): 857-861.], articleTitle=磁共振评估心肌梗死再灌注后心肌内出血的研究进展, refAbstract=null), Reference(id=1208154047807337172, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2018, volume=97, issue=30, pageStart=e11617, pageEnd=null, url=null, language=null, rfNumber=[9], rfOrder=10, authorNames=Ma M, Diao KY, Yang ZG, journalName=Medicine (Baltimore), refType=null, unstructuredReference=Ma M, Diao KY, Yang ZG, et al. Clinical associations of microvascular obstruction and intramyocardial hemorrhage on cardiovascular magnetic resonance in patients with acute ST segment elevation myocardial infarction (STEMI): an observational cohort study[J]. Medicine (Baltimore), 2018, 97(30): e11617., articleTitle=Clinical associations of microvascular obstruction and intramyocardial hemorrhage on cardiovascular magnetic resonance in patients with acute ST segment elevation myocardial infarction (STEMI): an observational cohort study, refAbstract=null), Reference(id=1208154047916389079, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2021, volume=301, issue=1, pageStart=4, pageEnd=18, url=null, language=null, rfNumber=[10], rfOrder=11, authorNames=Beijnink CWH, van der Hoeven NW, Konijnenberg LSF, journalName=Radiology, refType=null, unstructuredReference=Beijnink CWH, van der Hoeven NW, Konijnenberg LSF, et al. Cardiac MRI to visualize myocardial damage after ST-segment elevation myocardial infarction: a review of its histologic validation[J]. Radiology, 2021, 301(1): 4-18., articleTitle=Cardiac MRI to visualize myocardial damage after ST-segment elevation myocardial infarction: a review of its histologic validation, refAbstract=null), Reference(id=1208154048109327074, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2016, volume=5, issue=2, pageStart=e002834, pageEnd=null, url=null, language=null, rfNumber=[11], rfOrder=12, authorNames=Carrick D, Haig C, Ahmed N, journalName=J Am Heart Assoc, refType=null, unstructuredReference=Carrick D, Haig C, Ahmed N, et al. Temporal evolution of myocardial hemorrhage and edema in patients after acute ST-segment elevation myocardial infarction: pathophysiological insights and clinical implications[J]. J Am Heart Assoc, 2016, 5(2): e002834., articleTitle=Temporal evolution of myocardial hemorrhage and edema in patients after acute ST-segment elevation myocardial infarction: pathophysiological insights and clinical implications, refAbstract=null), Reference(id=1208154048193213160, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2016, volume=9, issue=1, pageStart=e004148, pageEnd=null, url=null, language=null, rfNumber=[12], rfOrder=13, authorNames=Carrick D, Haig C, Ahmed N, journalName=Circ Cardiovasc Imaging, refType=null, unstructuredReference=Carrick D, Haig C, Ahmed N, et al. Myocardial hemorrhage after acute reperfused ST-segment-elevation myocardial infarction: relation to microvascular obstruction and prognostic significance[J]. Circ Cardiovasc Imaging, 2016, 9(1): e004148., articleTitle=Myocardial hemorrhage after acute reperfused ST-segment-elevation myocardial infarction: relation to microvascular obstruction and prognostic significance, refAbstract=null), Reference(id=1208154048293876460, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2015, volume=12, issue=3, pageStart=156, pageEnd=167, url=null, language=null, rfNumber=[13], rfOrder=14, authorNames=Betgem RP, de Waard GA, Nijveldt R, journalName=Nat Rev Cardiol, refType=null, unstructuredReference=Betgem RP, de Waard GA, Nijveldt R, et al. Intramyocardial haemorrhage after acute myocardial infarction[J]. Nat Rev Cardiol, 2015, 12(3): 156-167., articleTitle=Intramyocardial haemorrhage after acute myocardial infarction, refAbstract=null), Reference(id=1208154048381956849, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2012, volume=79, issue=7, pageStart=1101, pageEnd=1108, url=null, language=null, rfNumber=[14], rfOrder=15, authorNames=Amabile N, Jacquier A, Shuhab A, journalName=Catheter Cardiovasc Interv, refType=null, unstructuredReference=Amabile N, Jacquier A, Shuhab A, et al. Incidence, predictors, and prognostic value of intramyocardial hemorrhage lesions in ST elevation myocardial infarction[J]. Catheter Cardiovasc Interv, 2012, 79(7): 1101-1108., articleTitle=Incidence, predictors, and prognostic value of intramyocardial hemorrhage lesions in ST elevation myocardial infarction, refAbstract=null), Reference(id=1208154048511980278, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2017, volume=6, issue=8, pageStart=e005651, pageEnd=null, url=null, language=null, rfNumber=[15], rfOrder=16, authorNames=Amier RP, Tijssen RYG, Teunissen PFA, journalName=J Am Heart Assoc, refType=null, unstructuredReference=Amier RP, Tijssen RYG, Teunissen PFA, et al. Predictors of intramyocardial hemorrhage after reperfused ST-segment elevation myocardial infarction[J]. J Am Heart Assoc, 2017, 6(8): e005651., articleTitle=Predictors of intramyocardial hemorrhage after reperfused ST-segment elevation myocardial infarction, refAbstract=null), Reference(id=1208154048612643577, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2020, volume=11, issue=8, pageStart=1639, pageEnd=1644, url=null, language=null, rfNumber=[16], rfOrder=17, authorNames=Goyal A, Gupta Y, Singla R, journalName=Diabetes Ther, refType=null, unstructuredReference=Goyal A, Gupta Y, Singla R, et al. American Diabetes Association"standards of medical care-2020 for gestational diabetes mellitus": a critical appraisal[J]. Diabetes Ther, 2020, 11(8):1639-1644., articleTitle=American Diabetes Association"standards of medical care-2020 for gestational diabetes mellitus": a critical appraisal, refAbstract=null), Reference(id=1208154048692335357, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2019, volume=139, issue=25, pageStart=e1082, pageEnd=e1143, url=null, language=null, rfNumber=[17], rfOrder=18, authorNames=Grundy SM, Stone NJ, Bailey AL, journalName=Circulation, refType=null, unstructuredReference=Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American college of cardiology/American heart association task force on clinical practice guidelines[J]. Circulation, 2019, 139(25): e1082-e1143., articleTitle=2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American college of cardiology/American heart association task force on clinical practice guidelines, refAbstract=null), Reference(id=1208154048826553089, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2018, volume=71, issue=19, pageStart=e127, pageEnd=e248, url=null, language=null, rfNumber=[18], rfOrder=19, authorNames=Whelton PK, Carey RM, Aronow WS, journalName=J Am Coll Cardiol, refType=null, unstructuredReference=Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines[J]. J Am Coll Cardiol, 2018, 71(19): e127-e248., articleTitle=2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines, refAbstract=null), Reference(id=1208154048906244867, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2018, volume=137, issue=18, pageStart=1949, pageEnd=1964, url=null, language=null, rfNumber=[19], rfOrder=20, authorNames=Bulluck H, Dharmakumar R, Arai AE, journalName=Circulation, refType=null, unstructuredReference=Bulluck H, Dharmakumar R, Arai AE, et al. Cardiovascular magnetic resonance in acute ST-segment-elevation myocardial infarction: recent advances, controversies, and future directions[J]. Circulation, 2018, 137(18): 1949-1964., articleTitle=Cardiovascular magnetic resonance in acute ST-segment-elevation myocardial infarction: recent advances, controversies, and future directions, refAbstract=null), Reference(id=1208154048981742343, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2019, volume=8, issue=11, pageStart=1805, pageEnd=null, url=null, language=null, rfNumber=[20], rfOrder=21, authorNames=Rios-Navarro C, Marcos-Garces V, Bayes-Genis A, journalName=J Clin Med, refType=null, unstructuredReference=Rios-Navarro C, Marcos-Garces V, Bayes-Genis A, et al. Microvascular obstruction in ST-segment elevation myocardial infarction: Looking back to move forward. Focus on CMR[J]. J Clin Med, 2019, 8(11): 1805., articleTitle=Microvascular obstruction in ST-segment elevation myocardial infarction: Looking back to move forward. Focus on CMR, refAbstract=null), Reference(id=1208154049115960074, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2016, volume=37, issue=13, pageStart=1024, pageEnd=1033, url=null, language=null, rfNumber=[21], rfOrder=22, authorNames=Niccoli G, Scalone G, Lerman A, journalName=Eur Heart J, refType=null, unstructuredReference=Niccoli G, Scalone G, Lerman A, et al. Coronary microvascular obstruction in acute myocardial infarction[J]. Eur Heart J, 2016, 37(13): 1024-1033., articleTitle=Coronary microvascular obstruction in acute myocardial infarction, refAbstract=null), Reference(id=1208154049178874637, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2019, volume=115, issue=7, pageStart=1143, pageEnd=1155, url=null, language=null, rfNumber=[22], rfOrder=23, authorNames=Hausenloy DJ, Chilian W, Crea F, journalName=Cardiovasc Res, refType=null, unstructuredReference=Hausenloy DJ, Chilian W, Crea F, et al. The coronary circulation in acute myocardial ischaemia/reperfusion injury: a target for cardioprotection[J]. Cardiovasc Res, 2019, 115(7): 1143-1155., articleTitle=The coronary circulation in acute myocardial ischaemia/reperfusion injury: a target for cardioprotection, refAbstract=null), Reference(id=1208154049266955026, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2019, volume=92, issue=3, pageStart=216, pageEnd=219, url=null, language=null, rfNumber=[23], rfOrder=24, authorNames=Marc MC, Iancu AC, Bălănescu Ş, journalName=Med Pharm Rep, refType=null, unstructuredReference=Marc MC, Iancu AC, Bălănescu Ş, et al. Microvascular obstruction in acute myocardial infarction: an old and unsolved mystery[J]. Med Pharm Rep, 2019, 92(3): 216-219., articleTitle=Microvascular obstruction in acute myocardial infarction: an old and unsolved mystery, refAbstract=null), Reference(id=1208154049367618326, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2010, volume=26, issue=1, pageStart=49, pageEnd=55, url=null, language=null, rfNumber=[24], rfOrder=25, authorNames=Beek AM, Nijveldt R, van Rossum AC, journalName=Int J Cardiovasc Imaging, refType=null, unstructuredReference=Beek AM, Nijveldt R, van Rossum AC. Intramyocardial hemorrhage and microvascular obstruction after primary percutaneous coronary intervention[J]. Int J Cardiovasc Imaging, 2010, 26(1): 49-55., articleTitle=Intramyocardial hemorrhage and microvascular obstruction after primary percutaneous coronary intervention, refAbstract=null), Reference(id=1208154049468281628, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2009, volume=30, issue=12, pageStart=1440, pageEnd=1449, url=null, language=null, rfNumber=[25], rfOrder=26, authorNames=Ganame J, Messalli G, Dymarkowski S, journalName=Eur Heart J, refType=null, unstructuredReference=Ganame J, Messalli G, Dymarkowski S, et al. Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction[J]. Eur Heart J, 2009, 30(12): 1440-1449., articleTitle=Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction, refAbstract=null), Reference(id=1208154049577333534, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2013, volume=167, issue=5, pageStart=2047, pageEnd=2054, url=null, language=null, rfNumber=[26], rfOrder=27, authorNames=Husser O, Monmeneu JV, Sanchis J, journalName=Int J Cardiol, refType=null, unstructuredReference=Husser O, Monmeneu JV, Sanchis J, et al. Cardiovascular magnetic resonance-derived intramyocardial hemorrhage after STEMI: influence on long-term prognosis, adverse left ventricular remodeling and relationship with microvascular obstruction[J]. Int J Cardiol, 2013, 167(5): 2047-2054., articleTitle=Cardiovascular magnetic resonance-derived intramyocardial hemorrhage after STEMI: influence on long-term prognosis, adverse left ventricular remodeling and relationship with microvascular obstruction, refAbstract=null), Reference(id=1208154049682191138, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2014, volume=7, issue=9, pageStart=940, pageEnd=952, url=null, language=null, rfNumber=[27], rfOrder=28, authorNames=Hamirani YS, Wong A, Kramer CM, journalName=JACC Cardiovasc Imaging, refType=null, unstructuredReference=Hamirani YS, Wong A, Kramer CM, et al. Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis[J]. JACC Cardiovasc Imaging, 2014, 7(9): 940-952., articleTitle=Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis, refAbstract=null), Reference(id=1208154049791243047, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=1990, volume=137, issue=2, pageStart=301, pageEnd=311, url=null, language=null, rfNumber=[28], rfOrder=29, authorNames=Garcia-Dorado D, Théroux P, Solares J, journalName=Am J Pathol, refType=null, unstructuredReference=Garcia-Dorado D, Théroux P, Solares J, et al. Determinants of hemorrhagic infarcts. Histologic observations from experiments involving coronary occlusion, coronary reperfusion, and reocclusion[J]. Am J Pathol, 1990, 137(2): 301-311., articleTitle=Determinants of hemorrhagic infarcts. Histologic observations from experiments involving coronary occlusion, coronary reperfusion, and reocclusion, refAbstract=null), Reference(id=1208154049933849387, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2021, volume=79, issue=null, pageStart=1, pageEnd=4, url=null, language=null, rfNumber=[29], rfOrder=30, authorNames=Thomas R, Thai K, Barry J, journalName=Magn Reson Imaging, refType=null, unstructuredReference=Thomas R, Thai K, Barry J, et al. T2-based area-at-risk and edema are influenced by ischemic duration in acute myocardial infarction[J]. Magn Reson Imaging, 2021, 79: 1-4., articleTitle=T2-based area-at-risk and edema are influenced by ischemic duration in acute myocardial infarction, refAbstract=null), Reference(id=1208154049996763952, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2017, volume=38, issue=47, pageStart=3511, pageEnd=3513, url=null, language=null, rfNumber=[30], rfOrder=31, authorNames=Kloner RA, journalName=Eur Heart J, refType=null, unstructuredReference=Kloner RA. The importance of no-reflow/microvascular obstruction in the STEMI patient[J]. Eur Heart J, 2017, 38(47):3511-3513., articleTitle=The importance of no-reflow/microvascular obstruction in the STEMI patient, refAbstract=null), Reference(id=1208154050068067124, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2015, volume=10, issue=12, pageStart=e0145495, pageEnd=null, url=null, language=null, rfNumber=[31], rfOrder=32, authorNames=Arcari L, Cimino S, de Luca L, journalName=PLoS One, refType=null, unstructuredReference=Arcari L, Cimino S, de Luca L, et al. Impact of heart rate on myocardial salvage in timely reperfused patients with ST-segment elevation myocardial infarction: new insights from cardiovascular magnetic resonance[J]. PLoS One, 2015, 10(12): e0145495., articleTitle=Impact of heart rate on myocardial salvage in timely reperfused patients with ST-segment elevation myocardial infarction: new insights from cardiovascular magnetic resonance, refAbstract=null), Reference(id=1208154050147758901, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2019, volume=70, issue=8, pageStart=774, pageEnd=781, url=null, language=null, rfNumber=[32], rfOrder=33, authorNames=Ma X, Wang Z, Wang J, journalName=Angiology, refType=null, unstructuredReference=Ma X, Wang Z, Wang J, et al. Admission heart rate is associated with coronary artery disease severity and complexity in patients with acute coronary syndrome[J]. Angiology, 2019, 70(8): 774-781., articleTitle=Admission heart rate is associated with coronary artery disease severity and complexity in patients with acute coronary syndrome, refAbstract=null), Reference(id=1208154050252616506, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2016, volume=219, issue=null, pageStart=339, pageEnd=344, url=null, language=null, rfNumber=[33], rfOrder=34, authorNames=Reindl M, Reinstadler SJ, Feistritzer HJ, journalName=Int J Cardiol, refType=null, unstructuredReference=Reindl M, Reinstadler SJ, Feistritzer HJ, et al. Heart rate and left ventricular adverse remodelling after ST-elevation myocardial infarction[J]. Int J Cardiol, 2016, 219: 339-344., articleTitle=Heart rate and left ventricular adverse remodelling after ST-elevation myocardial infarction, refAbstract=null), Reference(id=1208154050340696894, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2016, volume=41, issue=3, pageStart=233, pageEnd=240, url=null, language=null, rfNumber=[34], rfOrder=35, authorNames=Perne A, Schmidt FP, Hochadel M, journalName=Herz, refType=null, unstructuredReference=Perne A, Schmidt FP, Hochadel M, et al. Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction[J]. Herz, 2016, 41(3): 233-240., articleTitle=Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction, refAbstract=null), Reference(id=1208154050458137407, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, doi=null, pmid=null, pmcid=null, year=2016, volume=9, issue=10, pageStart=e004940, pageEnd=null, url=null, language=null, rfNumber=[35], rfOrder=36, authorNames=Bulluck H, Rosmini S, Abdel-Gadir A, journalName=Circ Cardiovasc Imaging, refType=null, unstructuredReference=Bulluck H, Rosmini S, Abdel-Gadir A, et al. Residual myocardial iron following intramyocardial hemorrhage during the convalescent phase of reperfused ST-segment-elevation myocardial infarction and adverse left ventricular remodeling[J]. Circ Cardiovasc Imaging, 2016, 9(10): e004940., articleTitle=Residual myocardial iron following intramyocardial hemorrhage during the convalescent phase of reperfused ST-segment-elevation myocardial infarction and adverse left ventricular remodeling, refAbstract=null)], funds=[Fund(id=1208154046704235154, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, awardId=Z-2019-42-1908-2, language=EN, fundingSource=China Special Fund for Cardiovascular Disease Development(Z-2019-42-1908-2), fundOrder=null, country=null), Fund(id=1208154046804898455, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, awardId=Z-2019-42-1908-2, language=CN, fundingSource=中华心血管病发展专项基金(Z-2019-42-1908-2), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1208154042551873927, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, xref=1, ext=[AuthorCompanyExt(id=1208154042560262536, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, companyId=1208154042551873927, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Chinese PLA Medical School, Beijing 100853, China), AuthorCompanyExt(id=1208154042577039754, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, companyId=1208154042551873927, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1解放军医学院，北京 100853)]), AuthorCompany(id=1208154042660925841, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, xref=2, ext=[AuthorCompanyExt(id=1208154042669314450, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, companyId=1208154042660925841, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Cardiology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China), AuthorCompanyExt(id=1208154042677703059, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, companyId=1208154042660925841, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2解放军总医院第一医学中心心血管内科，北京 100853)])], figs=[ArticleFig(id=1208154045802459745, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=EN, label=Fig.1, caption=Cardiac magnetic resonance (CMR) findings on LGE and T2WI images in two groups of AMI patients, figureFileSmall=7RHvHHhdsgelY5DnBPuWDA==, figureFileBig=3kr5+tZ4RhTsHBrl/YnzkA==, tableContent=null), ArticleFig(id=1208154045877957225, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=CN, label=图1, caption=两组急性心肌梗死患者LGE像、T2WI像心脏磁共振(CMR)的表现

LGE. 钆对比剂延迟增强扫描；T2WI. T2加权；IMH. 心肌内出血；图中绿色、蓝色框内示梗死区域；黄色框内示心肌水肿，无IMH；红色框内示IMH

, figureFileSmall=7RHvHHhdsgelY5DnBPuWDA==, figureFileBig=3kr5+tZ4RhTsHBrl/YnzkA==, tableContent=null), ArticleFig(id=1208154046079283829, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=EN, label=Tab.1, caption=

Comparison of baseline data in patients with AMI between the two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
项目IMH阴性组(n=117)IMH阳性组(n=87)t/χ2/ZP
年龄(岁，$\bar{x}±s$)56.29±11.3456.33±10.84–0.0240.981
女性[例(%)]10(8.6)11(12.6)0.9070.360
BMI[kg/m2, M(Q1, Q3)]25.02(23.27,27.31)25.83(23.88,27.96)–1.5390.124
高血压史[例(%)]54(46.2)48(55.2)1.6230.257
糖尿病史[例(%)]11(9.4)28(32.2)16.749<0.001
高脂血症史[例(%)]17(14.5)24(27.6)5.2960.033
心血管病家族史[例(%)]18(15.4)6(6.9)3.4630.079
心肌梗死史[例(%)]5(4.3)5(5.8)0.2320.747
PCI史[例(%)]5(4.3)4(4.6)0.0121.000
CABG史[例(%)]1(0.9)1(1.2)0.0451.000
吸烟史[例(%)]61(52.1)47(54.0)0.6240.474
饮酒史[例(%)]24(20.5)22(25.3)0.6510.499
), ArticleFig(id=1208154046150587001, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=CN, label=表1, caption=

两组急性心肌梗死患者的基线资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目IMH阴性组(n=117)IMH阳性组(n=87)t/χ2/ZP
年龄(岁，$\bar{x}±s$)56.29±11.3456.33±10.84–0.0240.981
女性[例(%)]10(8.6)11(12.6)0.9070.360
BMI[kg/m2, M(Q1, Q3)]25.02(23.27,27.31)25.83(23.88,27.96)–1.5390.124
高血压史[例(%)]54(46.2)48(55.2)1.6230.257
糖尿病史[例(%)]11(9.4)28(32.2)16.749<0.001
高脂血症史[例(%)]17(14.5)24(27.6)5.2960.033
心血管病家族史[例(%)]18(15.4)6(6.9)3.4630.079
心肌梗死史[例(%)]5(4.3)5(5.8)0.2320.747
PCI史[例(%)]5(4.3)4(4.6)0.0121.000
CABG史[例(%)]1(0.9)1(1.2)0.0451.000
吸烟史[例(%)]61(52.1)47(54.0)0.6240.474
饮酒史[例(%)]24(20.5)22(25.3)0.6510.499
), ArticleFig(id=1208154046247055995, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=EN, label=Tab.2, caption=

Comparison of perioperative related indexes in patients with AMI between the two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
项目IMH阴性组(n=117)IMH阳性组(n=87)χ2/t/ZP
缺血总时间[min,M(Q1,Q3)]175(124,237)327(227,511)–7.354<0.001
入院血糖[mmol/L,M(Q1,Q3)]7.10(6.38,8.53)8.90(7.29,11.06)–4.805<0.001
入院收缩压(mmHg,$\bar{x}±s$)130.15±25.89135.77±24.04–1.5800.116
入院舒张压(mmHg,$\bar{x}±s$)82.33±17.6682.95±19.68–0.2360.813
入院脉压差[mmHg,M(Q1,Q3)]47(37,58)49(40,59)–1.6740.094
入院心率(次/min,$\bar{x}±s$)74.19±16.9880.48±13.68–2.8390.005
血红蛋白下降值[g/L,M(Q1,Q3)]7(0.5,16.0)12(6,22)–3.0830.002
CK-MB峰值[U/L,M(Q1,Q3)]130.10(59.47,234.15)224.70(105.90,298.30)–3.3530.001
TnT峰值[ng/ml,M(Q1,Q3)]3.71(1.72,6.66)5.65(3.44,8.19)–3.2070.001
低密度脂蛋白胆固醇[mmol/L,$\bar{x}±s$]2.92±0.873.19±0.73–2.4400.016
前壁梗死[例(%)]45(38.5)52(59.8)9.0840.003
术前TIMI血流<3级[例(%)]95(81.2)81(93.1)5.9740.022
使用GPⅡb/Ⅲa受体拮抗剂[例(%)]  11.1570.001
 仅肝素50(42.7)18(20.7)
 仅比伐卢定3(2.56)2(2.30)
 替罗非班联合肝素或比伐卢定64(54.7)67(77.0)
病变血管支数[例(%)]  5.3100.070
 138(32.5)17(19.5)
 245(38.5)34(39.1)
 334(29.1)36(41.4)
置入支架数量[例(%)]  1.6231.000
 127(23.1)24(27.6)
 263(53.8)39(44.8)
 ≥327(23.1)24(27.6)
梗死程度[%,M(Q1,Q3)]15.65(13.25,19.44)25.30(18.39,31.87)–7.109<0.001
LVEF[%,M(Q1,Q3)]52(46,55)49(43,53)–2.3030.021
), ArticleFig(id=1208154046364496513, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=CN, label=表2, caption=

两组急性心肌梗死患者围术期相关指标比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目IMH阴性组(n=117)IMH阳性组(n=87)χ2/t/ZP
缺血总时间[min,M(Q1,Q3)]175(124,237)327(227,511)–7.354<0.001
入院血糖[mmol/L,M(Q1,Q3)]7.10(6.38,8.53)8.90(7.29,11.06)–4.805<0.001
入院收缩压(mmHg,$\bar{x}±s$)130.15±25.89135.77±24.04–1.5800.116
入院舒张压(mmHg,$\bar{x}±s$)82.33±17.6682.95±19.68–0.2360.813
入院脉压差[mmHg,M(Q1,Q3)]47(37,58)49(40,59)–1.6740.094
入院心率(次/min,$\bar{x}±s$)74.19±16.9880.48±13.68–2.8390.005
血红蛋白下降值[g/L,M(Q1,Q3)]7(0.5,16.0)12(6,22)–3.0830.002
CK-MB峰值[U/L,M(Q1,Q3)]130.10(59.47,234.15)224.70(105.90,298.30)–3.3530.001
TnT峰值[ng/ml,M(Q1,Q3)]3.71(1.72,6.66)5.65(3.44,8.19)–3.2070.001
低密度脂蛋白胆固醇[mmol/L,$\bar{x}±s$]2.92±0.873.19±0.73–2.4400.016
前壁梗死[例(%)]45(38.5)52(59.8)9.0840.003
术前TIMI血流<3级[例(%)]95(81.2)81(93.1)5.9740.022
使用GPⅡb/Ⅲa受体拮抗剂[例(%)]  11.1570.001
 仅肝素50(42.7)18(20.7)
 仅比伐卢定3(2.56)2(2.30)
 替罗非班联合肝素或比伐卢定64(54.7)67(77.0)
病变血管支数[例(%)]  5.3100.070
 138(32.5)17(19.5)
 245(38.5)34(39.1)
 334(29.1)36(41.4)
置入支架数量[例(%)]  1.6231.000
 127(23.1)24(27.6)
 263(53.8)39(44.8)
 ≥327(23.1)24(27.6)
梗死程度[%,M(Q1,Q3)]15.65(13.25,19.44)25.30(18.39,31.87)–7.109<0.001
LVEF[%,M(Q1,Q3)]52(46,55)49(43,53)–2.3030.021
), ArticleFig(id=1208154046481937031, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=EN, label=Tab.3, caption=

Univariate and multivariate logistic regression analysis for presence of IMH after primary PCI in acute STEMI patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素多因素
OR95%CIPOR95%CIP
BMI1.0980.997~1.2090.057–––
糖尿病史4.5732.125~9.844<0.0017.8722.009~30.8460.003
高脂血症病史2.0291.026~4.0150.0420.6020.196~1.8460.375
缺血总时间1.0071.005~1.0100.0071.0111.007~1.014<0.001
脉压差1.0171.000~1.0340.0491.0110.984~1.0390.434
入院心率1.0261.007~1.0450.0061.0411.012~1.0710.006
入院血糖1.2751.129~1.441<0.0011.4281.182~1.725<0.001
血红蛋白下降值1.0471.017~1.0770.0021.1171.059~1.178<0.001
CK-MB峰值1.0031.001~1.0050.0041.0061.002~1.0100.007
TnT峰值1.0521.005~1.1020.0290.9770.904~1.0550.546
低密度脂蛋白胆固醇1.5321.079~2.1750.0170.9810.561~1.7150.945
前壁梗死2.3771.347~4.1940.0033.3591.307~8.6330.012
术前TIMI血流<3级5.3551.784~16.0720.0031.6750.338~8.2960.527
使用GPⅡb/Ⅲa受体拮抗剂2.8711.548~5.3250.0013.3621.195~9.4600.022
), ArticleFig(id=1208154046586794636, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208154039762661731, language=CN, label=表3, caption=

急性STEMI患者直接PCI术后发生IMH危险因素的单因素、多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素多因素
OR95%CIPOR95%CIP
BMI1.0980.997~1.2090.057–––
糖尿病史4.5732.125~9.844<0.0017.8722.009~30.8460.003
高脂血症病史2.0291.026~4.0150.0420.6020.196~1.8460.375
缺血总时间1.0071.005~1.0100.0071.0111.007~1.014<0.001
脉压差1.0171.000~1.0340.0491.0110.984~1.0390.434
入院心率1.0261.007~1.0450.0061.0411.012~1.0710.006
入院血糖1.2751.129~1.441<0.0011.4281.182~1.725<0.001
血红蛋白下降值1.0471.017~1.0770.0021.1171.059~1.178<0.001
CK-MB峰值1.0031.001~1.0050.0041.0061.002~1.0100.007
TnT峰值1.0521.005~1.1020.0290.9770.904~1.0550.546
低密度脂蛋白胆固醇1.5321.079~2.1750.0170.9810.561~1.7150.945
前壁梗死2.3771.347~4.1940.0033.3591.307~8.6330.012
术前TIMI血流<3级5.3551.784~16.0720.0031.6750.338~8.2960.527
使用GPⅡb/Ⅲa受体拮抗剂2.8711.548~5.3250.0013.3621.195~9.4600.022
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急性ST段抬高型心肌梗死直接PCI术后心肌内出血的危险因素分析
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姜子超 1, 2 , 刘康 1, 2 , 凌维维 1, 2 , 阿鑫 1, 2 , 吴丹 1, 2 , 钱赓 2, *
解放军医学杂志 | 临床研究 2022,47(2): 171-177
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解放军医学杂志 | 临床研究 2022, 47(2): 171-177
急性ST段抬高型心肌梗死直接PCI术后心肌内出血的危险因素分析
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姜子超1, 2, 刘康1, 2, 凌维维1, 2, 阿鑫1, 2, 吴丹1, 2, 钱赓2, *
作者信息
  • 1解放军医学院，北京 100853
  • 2解放军总医院第一医学中心心血管内科，北京 100853

    • 姜子超，硕士研究生，主要从事冠心病诊疗和心脏磁共振方面的临床研究

通讯作者:

钱赓，E-mail：
Related factors of intramyocardial hemorrhage in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention
Zi-Chao Jiang1, 2, Kang Liu1, 2, Wei-Wei Ling1, 2, Xin A1, 2, Dan Wu1, 2, Geng Qian2, *
Affiliations
  • 1Chinese PLA Medical School, Beijing 100853, China
  • 2Department of Cardiology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
出版时间: 2022-02-28 doi: 10.11855/j.issn.0577-7402.2022.02.0171
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目的 探讨急性ST段抬高型心肌梗死(STEMI)直接PCI术后心肌内出血(IMH)的影响因素。方法 收集2014年2月－2019年3月在解放军总医院第一医学中心急诊行直接PCI治疗，且于术后3~7 d行心脏磁共振检查的204例急性STEMI患者的临床资料进行回顾性分析。根据是否存在IMH分为IMH阳性组(n=87)与IMH阴性组(n=117)，分析两组患者临床特征的差异，并采用logistic回归分析IMH发生的影响因素。结果 与IMH阴性组比较，IMH阳性组缺血总时间、入院血糖、入院心率、血红蛋白下降值、肌酸激酶同工酶(CK-MB)峰值、肌钙蛋白T(TnT)峰值、低密度脂蛋白胆固醇、梗死程度等明显增高，左室射血分数(LVEF)明显降低，糖尿病史、高脂血症史、术前TIMI血流<3级、前壁梗死、使用GPⅡb/Ⅲa受体拮抗剂的患者比例高，差异均有统计学意义(P<0.05)。Logistic回归分析结果显示，糖尿病史(P=0.003，OR=7.782，95%CI 2.009~30.846)、缺血总时间(P<0.001，OR=1.011，95%CI 1.007~1.014)、入院血糖(P<0.001，OR=1.428，95%CI 1.182~1.725)、入院心率(P=0.006，OR=1.041，95%CI 1.012~1.071)、血红蛋白下降值(P<0.001，OR=1.117，95%CI 1.059~1.178)、CK-MB峰值(P=0.007，OR=1.006，95%CI 1.002~1.010)、前壁梗死(P=0.012，OR=3.359，95%CI 1.307~8.633)、使用GPⅡb/Ⅲa受体拮抗剂(P=0.022，OR=3.362，95%CI 1.195~9.460)是急性STEMI患者直接PCI术后发生IMH的独立危险因素。结论 糖尿病史、缺血总时间、入院血糖、入院心率、血红蛋白下降值、CK-MB峰值、前壁梗死、使用GPⅡb/Ⅲa受体拮抗剂等为急性STEMI直接PCI术后IMH的独立危险因素，可实施适当的策略予以干预。

心肌内出血  /  心肌梗死  /  经皮冠状动脉介入治疗  /  心脏磁共振

Objective To evaluate the predictors of the occurrence of intramyocardial hemorrhage (IMH) in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention. Methods A total of two hundred and four patients, admitted in the First Medical Center of Chinese PLA General Hospital from February, 2014 to March, 2019, diagnosed as STEMI undergoing emergency PCI treatment within the first 12 h of evolution, were screened for our retrospective analysis. IMH lesions were visualized by T2-weighted sequences on cardiac magnetic resonance (CMR) between days 3 to 7 after PCI. Based on the existence of IMH, all patients were classified into the non-IMH group (n=117) and the IMH group (n=87). We investigate the clinical features between the two groups. Factors influencing were analyzed by logistic regression analysis. Results Compared with the non-IMH group, the ischemia time, admission glucose, admission heart rate, hemoglobin(Hb) reduction, creatine kinase isoenzymes (CK-MB) peak value, troponin T (TnT) peak value, low-density lipoprotein cholesterol, infarct size were significantly higher and the left ventricular ejection fraction (LVEF) was significantly lower in IMH group(P<0.05). Besides, in the IMH group, the proportion of patients with diabetes mellitus history, hyperlipemia history, preprocedural thrombolysis in myocardial infarction (TIMI) flow grades <3, anterior infarction, periprocedural glycoprotein Ⅱb/Ⅲa inhibitor treatment was significantly higher (P<0.05). Logistic regression model presented that diabetes mellitus history (P=0.003, OR=7.782,95%CI 2.009-30.846), ischemia time (P<0.001, OR=1.011, 95%CI 1.007-1.014), admission glucose (P<0.001, OR=1.428, 95%CI 1.182-1.725), admission heart rate (P=0.006, OR=1.041, 95%CI 1.012-1.071), Hb reduction (P<0.001, OR=1.117, 95%CI 1.059-1.178), CK-MB peak value (P=0.007, OR=1.006, 95%CI 1.002-1.010), anterior infarction (P=0.042, OR=2.626, 95%CI 1.037-6.652) and periprocedural glycoprotein Ⅱb/Ⅲa inhibitor treatment (P=0.022, OR=3.362, 95%CI 1.195-9.460) were independent risk factors for IMH in acute STEMI patients undergoing PCI. Conclusion Diabetes mellitus history, ischemia time, admission glucose, admission heart rate, Hb reduction, CK-MB peak value, anterior infarction, periprocedural glycoprotein Ⅱb/Ⅲa inhibitor treatment were independent risk factors for IMH in the patients with acute STEMI undergoing primary PCI. Appropriate strategies for managing acute STEMI patients at high risk for IMH should be taken into consideration.

intramyocardial hemorrhage  /  myocardial infarction  /  percutaneous coronary intervention  /  cardiac magnetic resonance
姜子超, 刘康, 凌维维, 阿鑫, 吴丹, 钱赓. 急性ST段抬高型心肌梗死直接PCI术后心肌内出血的危险因素分析. 解放军医学杂志, 2022 , 47 (2) : 171 -177 . DOI: 10.11855/j.issn.0577-7402.2022.02.0171
Zi-Chao Jiang, Kang Liu, Wei-Wei Ling, Xin A, Dan Wu, Geng Qian. Related factors of intramyocardial hemorrhage in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention[J]. Medical Journal of Chinese People’s Liberation Army, 2022 , 47 (2) : 171 -177 . DOI: 10.11855/j.issn.0577-7402.2022.02.0171
正文
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经皮冠状动脉介入(percutaneous coronary intervention，PCI)是急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)的有效治疗方法，可及时恢复罪犯血管的灌注，明显减小梗死面积，降低并发症发生率，提高生存率，并明显改善预后[1-4]。但再灌注治疗在改善心肌供血的同时，也伴随着一系列再灌注损伤，如再灌注心律失常、心肌细胞代谢障碍及微血管结构损伤和功能障碍等，使再发心肌梗死、心力衰竭、心源性猝死等主要不良心血管事件(major adverse cardiovascular events，MACE)的发生风险明显增高[5-7]。其中，微血管结构损伤和功能障碍主要表现为微血管阻塞(microvascular obstructive，MVO)和心肌内出血(intramyocardial hemorrhage，IMH)，二者均可通过心脏磁共振成像(cardiac magnetic resonance，CMR)检查明确诊断[8-9]。目前研究发现，IMH是较MVO更为严重的缺血再灌注损伤，且与MVO相比，IMH与不良临床预后相关性更强[9-12]。因此，对于IMH的预测尤为重要。有研究证实，左前降支闭塞、溶栓后心肌梗死溶栓试验(TIMI)血流分级低、入院血糖水平高、ST段回落时间长、吸烟史、肌酸激酶同工酶(CK-MB)峰值高均可增加IMH的风险[13-15]，但上述研究仍存在结论不一致之处，如缺血总时间、血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)受体拮抗剂的使用[10,14-15]，而血红蛋白下降值、入院心率、基础血压等对于IMH的预测作用尚未见文献报道。本研究探讨了缺血总时间、血红蛋白的下降值、入院心率、基础血压、GPⅡb/Ⅲa受体拮抗剂的使用等对IMH发生的预测作用，旨在为急性STEMI患者的临床治疗和管理提供参考。
1 资料与方法
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1.1 研究对象
收集2014年2月－2019年3月在解放军总医院急诊行直接PCI治疗，且于术后3~7 d行CMR检查的204例患者的临床资料进行回顾性分析，以是否存在IMH作为变量，将患者分为IMH阳性组(n=87)与IMH阴性组(n=117)。纳入标准：(1)年龄18~80岁；(2)临床确诊的STEMI；(3)急诊行直接PCI治疗；(4)自愿参加，签署知情同意书。排除标准：(1)PCI术前出现心源性休克、Killip Ⅳ级、乳头肌断裂、室间隔穿孔、发作室速室颤及电复律后、Ⅲ度房室传导阻滞置入临时起搏器；(2)左室射血分数(LVEF)≤30%；(3)合并主动脉夹层；(4)存在瓣膜性心脏病、先天性心脏病及肺动脉高压及各类心肌病病史；(5)6个月内进行过血运重建[PCI或冠状动脉旁路移植术(CABG)]；(6)存在CMR检查禁忌；(7)目前或3个月内参与其他研究；(8)妊娠和哺乳期妇女；(9)严重精神障碍，无法表达意愿者；(10)存在其他明显的异常体征、实验室检查和临床疾病，根据临床医师判断，不适合参加研究的患者。本研究获解放军总医院伦理委员会批准(S2021-126-02)。
1.2 研究方法
1.2.1 资料收集
病例资料采集自解放军总医院住院病历管理系统。收集两组患者的一般基线资料[包括年龄、性别，以及心血管疾病危险因素如体重指数(body mass index，BMI)、高血压、糖尿病、高脂血症、既往心血管疾病治疗史、心血管疾病家族史及吸烟、饮酒史等]和围术期相关指标[如缺血总时间(发病至球囊扩张时间)、入院血糖、入院心率、入院血压、血红蛋白下降值(即术前术后血红蛋白的差值)、CK-MB峰值、肌钙蛋白T(TnT)峰值、低密度脂蛋白胆固醇、梗死部位、病变血管数量、术前心肌梗死溶栓试验(TIMI)血流分级、GPⅡb/Ⅲa受体拮抗剂的使用、置入支架数量等]。所有心血管危险因素定义均按指南推荐的定义执行[16-18]。
1.2.2 CMR扫描
使用1.5T MRI扫描装置(Ingenia，荷兰飞利浦)，采用稳态自由进动(bSSFP)序列完成覆盖全心的电影成像扫描。所有序列均取8 mm层厚，使不同图像类型之间的差异最小。钆对比剂延迟增强扫描(late gadolinium enhance，LGE)采用反转恢复序列，T2加权(T2WI)CMR采用快速自旋回波序列。
1.2.3 图像后处理
应用CVI42软件定量分析CMR测量参数，延迟增强程度的定量分析以半自动描记增强区域面积为基础，并以Simpson's法计算得出。延迟增强程度计算公式：梗死容量(ml)=Σ增强面积×层厚；梗死质量(g)=梗死容量×1.05；梗死程度(%)=梗死质量(g)/左室质量(g)×100%。电影序列成像后进行LVEF测定。IMH被定义为T2加权像高信号区内信号低(衰减)的区域[19]。以上数据的处理和诊断均由两位经验丰富的磁共振科医师分别独立完成。
1.3 指标分析
比较两组患者基线资料及围术期相关指标的差异；采用logistic回归分析筛选出有统计学意义的变量，并分析这些变量对IMH发生的预测作用。
1.4 统计学处理
采用SPSS 25.0软件进行统计分析。观察者内部一致性和观察者间一致性检验采用Kappa检验；采用Kolmogorov-Smirnov检验数据是否呈正态分布，呈正态分布的计量资料以$\bar{x}±s$表示，组间比较采用t检验，呈非正态分布的计量资料以M(Q1，Q3)表示，组间比较采用Mann-Whitney U检验；计数资料以例(%)表示，组间比较采用χ2检验或Fisher确切概率法；采用单因素及多因素logistic回归(enter法)分析发生IMH的危险因素。P<0.05为差异有统计学意义。
2 结果
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2.1 两组基线资料比较
两组患者行直接PCI术与CMR检查间隔时间分别为(5.94±0.66) d和(6.02±0.73) d，差异无统计学意义(P=0.398)。IMH阳性组有糖尿病史、高脂血症史的患者比例高于IMH阴性组，差异有统计学意义(P<0.05)；其余指标两组间差异均无统计学意义(P>0.05)(表1)。
2.2 CMR检查结果
CMR检查LGE像结果显示，IMH阴性组可见心室壁高信号区域(绿色框内)，IMH阳性组亦可见心室壁高信号区(蓝色框内)，提示IMH阳性组梗死面积较IMH阴性组更大；T2WI像结果显示，IMH阴性组可见心室壁高信号区域，为心肌水肿区域，未见IMH征象(黄色框内)，而IMH阳性组在心室壁高信号区域内部可见IMH低信号区域(红色框内)(图1)。
2.3 两组患者围术期相关指标比较
与IMH阴性组比较，IMH阳性组缺血总时间、入院血糖、入院心率、血红蛋白下降值、CK-MB峰值、TnT峰值、低密度脂蛋白胆固醇、梗死程度等明显增高，LVEF明显降低，术前TIMI血流<3级、使用GPⅡb/Ⅲa受体拮抗剂、前壁梗死的患者比例高，差异均有统计学意义(P<0.05)；两组入院收缩压、入院舒张压、入院脉压差、病变血管支数、支架置入数量等临床资料差异无统计学意义(P>0.05)(表2)。
2.4 IMH独立危险因素分析
采用logistic单因素回归分析将有统计学差异的变量纳入多因素logistic回归分析发现，糖尿病史、缺血总时间、入院血糖、入院心率、血红蛋白下降值、CK-MB峰值、前壁梗死、使用GPⅡb/Ⅲa受体拮抗剂是IMH发生的独立危险因素(P<0.05，表3)。
3 讨论
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心肌缺血再灌注损伤是影响急性STEMI直接PCI患者预后的重要因素[6]，其中，以MVO和IMH为主要表现的微血管结构损伤和功能障碍是心肌缺血再灌注损伤的主要环节[8]。MVO是指再灌注治疗后冠状动脉局部的微栓塞和缩血管因子释放等导致的冠状动脉远端微循环再灌注障碍[20-22]。目前认为，IMH是由于MVO区域内血管内皮结构和功能受损导致广泛的红细胞外渗而引起的，且与MVO相比，IMH与不良临床预后的相关性更强[11-12]。目前国际上对MVO的预测因素及其对预后的影响研究较为成熟[23]，而对IMH的研究尚不完善。本研究通过分析行直接PCI术的急性STEMI患者的临床资料发现，糖尿病史、缺血总时间、入院血糖、入院心率、血红蛋白下降值、CK-MB峰值、前壁梗死、使用GPⅡb/Ⅲa受体拮抗剂是急性STEMI直接PCI术后IMH的独立危险因素。
目前对于急性STEMI患者直接PCI术后IMH的发生率尚无定论。既往研究显示，直接PCI治疗急性STEMI后IMH的发生率为25%~54%[14,24-26]。Hamirani等[27]的Meta分析纳入了9项研究共1106例STEMI后行直接PCI治疗的患者，发现IMH发生率约为35%。本研究对204例急性STEMI患者直接PCI术后行CMR检查发现，87例(42.6%)患者梗死的心肌内存在IMH，可见IMH发生率并不低。
及时恢复急性STEMI罪犯血管的灌注已成为当前临床医师的共识。Garcia-Dorado等[28]发现，猪心肌梗死后缺血时间≥45 min时再灌注治疗的IMH发生率较高，而缺血时间<30 min时再灌注治疗的IMH发生率明显降低。Amabile等[14]发现，在单因素回归分析中，缺血时间与IMH的发生相关。本研究对204例行直接PCI治疗的急性STEMI患者进行多因素logistic回归分析发现，缺血总时间延长与IMH的发生密切相关，是IMH的独立危险因素。结合既往的研究结果，缺血总时间不仅可影响急性STEMI患者的生存率、梗死面积，也与心肌缺血再灌注损伤(如MVO和IMH)存在相关性[2-3,14,29-30]，因此仍是现阶段必须重视的一项危险因素。一方面应加强患者教育，尤其是存在心血管危险因素患者的教育，早期识别症状有利于缩短院前急救时间；另一方面要优化院外、院内急救流程，缩短门-球时间。
心率过快是心血管疾病的危险因素之一。Arcari等[31]发现，接受再灌注治疗的急性STEMI患者，PCI术前记录的心率过快与可挽救心肌的减少有关，尤其是当心率>85 次/min时，可挽救心肌明显减少。Ma等[32]发现，入院心率与急性冠脉综合征患者的SYNTAX评分呈明显正相关，且入院心率升高是急性冠脉综合征患者SYNTAX评分升高的独立预测因子，并有助于识别冠状动脉粥样硬化斑块负荷高的急性冠脉综合征患者。但入院心率与IMH发生的相关性尚未见报道。本研究结果显示，IMH阳性组入院心率较IMH阴性组明显增快；进一步行多因素logistic回归分析发现，入院心率是IMH的独立预测因素。其病理生理机制可能与心肌梗死后心率增快、心肌耗氧增加，同时心肌供氧减少，心肌耗氧与供氧之间的平衡被破坏有关，而缺氧进一步损伤了血管内皮系统的结构及功能，使红细胞外渗增加，从而增加了IMH的风险。既往研究发现，心率增快与急性STEMI患者的左室重构及预后密切相关[33-34]，其病理生理机制复杂，结合本研究结果，与高入院心率相关的IMH风险无疑增加了左室重构及预后不良的可能性，提示控制心率有助于预防心肌梗死后IMH的发生。
本研究结果发现，在行直接PCI治疗的急性STEMI患者中血红蛋白呈下降趋势，IMH阳性组血红蛋白下降值明显高于IMH阴性组，多因素logistic回归分析结果显示，血红蛋白的下降值也是IMH发生的独立预测因子。这可能与IMH的发生机制有关，即再灌注治疗后血管内皮屏障及微血管受损，梗死区内的红细胞外渗，而血红蛋白是红细胞内的重要物质。目前已有研究发现，在急性STEMI患者梗死心肌区域内存在残余铁沉积[35]，可能是外渗的血红蛋白被破坏所致，在一定程度上证实了本研究的结果。目前，临床上极少关注急性STEMI患者直接PCI术后血红蛋白的下降情况，国内外也罕有相关文献报道。本研究结果发现血红蛋白下降值与IMH存在相关性，提示IMH也是一种出血并发症，因此，临床上应更加关注急性STEMI患者术后血红蛋白变化的临床意义。
此外，本研究还分析了糖尿病史、入院血糖、CK-MB峰值、前壁梗死、GPⅡb/Ⅲa受体拮抗剂的使用与IMH的相关性，多因素logistics回归分析结果显示，上述临床因素均增加了IMH的发生风险，是IMH的独立危险因素。这与Ganame等[25]、Amabile等[14]的研究结果一致。虽然在PCI过程中给予GPⅡb/Ⅲa拮抗剂后急性STEMI患者心肌梗死面积有所减少，但同时也增加了IMH的风险，尤其易发于就诊延迟的患者，考虑IMH与患者远期左心室功能恢复及不良预后相关，因此，临床在选择抗凝方案时，应将其作为风险评估的一部分，并以此来制定适合高风险患者更有效的治疗策略。
目前，对于IMH的预防和治疗措施报道较少。根据已有的文献及本研究结果，笔者考虑可采取以下防治措施：(1)尽量缩短缺血总时间，包括院外就诊时间和院内急救时间，并加强患者心脏疾病相关急救常识的科学普及；(2)在STEMI患者首次医疗接触(first medical contact，FMC)时，医务人员应尽早给予吸氧、控制心率、控制血糖等干预措施；(3)院内急救时，对于IMH高风险人群应慎重选择GPⅡb/Ⅲa受体拮抗剂。
综上所述，本研究分析了IMH发生的独立危险因素，有利于临床上早期识别IMH，以及对存在IMH高风险的患者尽早采取适当的干预措施。本研究纳入了204例符合纳入、不符合排除标准的患者，但样本量仍相对不足，需要更大的样本量来进一步验证。此外，笔者后续将完善入组患者术后6个月的第2次CMR检查，并对患者持续进行随访，以了解发生IMH患者的心脏结构、功能的变化及预后情况，进一步分析IMH危险因素与患者心脏结构、功能及预后的相关性。
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排序方式：
[1]
Vogel B, Claessen BE, Arnold SV, et al. ST-segment elevation myocardial infarction[J]. Nat Rev Dis Primers, 2019, 5(1): 39.
[2]
American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Reperfusion Therapy for Acute ST-Segment Elevation Myocardial Infarction, Promes SB, Glauser JM, et al. Clinical policy: emergency department management of patients needing reperfusion therapy for acute ST-segment elevation myocardial infarction[J]. Ann Emerg Med, 2017, 70(5): 724-739.
[3]
Ibánez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation[J]. Rev Esp Cardiol (Engl Ed), 2017, 70(12): 1082.
[4]
Cheng B, Gao LY. Effect of early intervene in non-culprit vessels on the prognosis of patients with acute ST-segment elevation myocardial infarction presenting with multivessel disease[J]. Med J Chin PLA, 2020, 45(4): 441-446.
[成彪, 高凌云. 早期干预非罪犯血管对急性ST段抬高型心肌梗死合并多支血管病变患者预后的影响[J]. 解放军医学杂志, 2020, 45(4): 441-446.]
[5]
Gunata M, Parlakpinar H. A review of myocardial ischaemia/reperfusion injury: Pathophysiology, experimental models, biomarkers, genetics and pharmacological treatment[J]. Cell Biochem Funct, 2021, 39(2): 190-217.
[6]
Neri M, Riezzo I, Pascale N, et al. Ischemia/reperfusion injury following acute myocardial infarction: a critical issue for clinicians and forensic pathologists[J]. Mediators Inflamm, 2017, 2017: 7018393.
[7]
Ibáñez B, Heusch G, Ovize M, et al. Evolving therapies for myocardial ischemia/reperfusion injury[J]. J Am Coll Cardiol, 2015, 65(14): 1454-1471.
[8]
Liu DY, Cao F. Advances in intramyocardial hemorrhage of perfused acute myocardial infarction by cardiovascular magnetic resonance[J]. Med J Chin PLA, 2020, 45(8): 857-861.
[刘冬月, 曹丰. 磁共振评估心肌梗死再灌注后心肌内出血的研究进展[J]. 解放军医学杂志, 2020, 45(8): 857-861.]
[9]
Ma M, Diao KY, Yang ZG, et al. Clinical associations of microvascular obstruction and intramyocardial hemorrhage on cardiovascular magnetic resonance in patients with acute ST segment elevation myocardial infarction (STEMI): an observational cohort study[J]. Medicine (Baltimore), 2018, 97(30): e11617.
[10]
Beijnink CWH, van der Hoeven NW, Konijnenberg LSF, et al. Cardiac MRI to visualize myocardial damage after ST-segment elevation myocardial infarction: a review of its histologic validation[J]. Radiology, 2021, 301(1): 4-18.
[11]
Carrick D, Haig C, Ahmed N, et al. Temporal evolution of myocardial hemorrhage and edema in patients after acute ST-segment elevation myocardial infarction: pathophysiological insights and clinical implications[J]. J Am Heart Assoc, 2016, 5(2): e002834.
[12]
Carrick D, Haig C, Ahmed N, et al. Myocardial hemorrhage after acute reperfused ST-segment-elevation myocardial infarction: relation to microvascular obstruction and prognostic significance[J]. Circ Cardiovasc Imaging, 2016, 9(1): e004148.
[13]
Betgem RP, de Waard GA, Nijveldt R, et al. Intramyocardial haemorrhage after acute myocardial infarction[J]. Nat Rev Cardiol, 2015, 12(3): 156-167.
[14]
Amabile N, Jacquier A, Shuhab A, et al. Incidence, predictors, and prognostic value of intramyocardial hemorrhage lesions in ST elevation myocardial infarction[J]. Catheter Cardiovasc Interv, 2012, 79(7): 1101-1108.
[15]
Amier RP, Tijssen RYG, Teunissen PFA, et al. Predictors of intramyocardial hemorrhage after reperfused ST-segment elevation myocardial infarction[J]. J Am Heart Assoc, 2017, 6(8): e005651.
[16]
Goyal A, Gupta Y, Singla R, et al. American Diabetes Association"standards of medical care-2020 for gestational diabetes mellitus": a critical appraisal[J]. Diabetes Ther, 2020, 11(8):1639-1644.
[17]
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American college of cardiology/American heart association task force on clinical practice guidelines[J]. Circulation, 2019, 139(25): e1082-e1143.
[18]
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines[J]. J Am Coll Cardiol, 2018, 71(19): e127-e248.
[19]
Bulluck H, Dharmakumar R, Arai AE, et al. Cardiovascular magnetic resonance in acute ST-segment-elevation myocardial infarction: recent advances, controversies, and future directions[J]. Circulation, 2018, 137(18): 1949-1964.
[20]
Rios-Navarro C, Marcos-Garces V, Bayes-Genis A, et al. Microvascular obstruction in ST-segment elevation myocardial infarction: Looking back to move forward. Focus on CMR[J]. J Clin Med, 2019, 8(11): 1805.
[21]
Niccoli G, Scalone G, Lerman A, et al. Coronary microvascular obstruction in acute myocardial infarction[J]. Eur Heart J, 2016, 37(13): 1024-1033.
[22]
Hausenloy DJ, Chilian W, Crea F, et al. The coronary circulation in acute myocardial ischaemia/reperfusion injury: a target for cardioprotection[J]. Cardiovasc Res, 2019, 115(7): 1143-1155.
[23]
Marc MC, Iancu AC, Bălănescu Ş, et al. Microvascular obstruction in acute myocardial infarction: an old and unsolved mystery[J]. Med Pharm Rep, 2019, 92(3): 216-219.
[24]
Beek AM, Nijveldt R, van Rossum AC. Intramyocardial hemorrhage and microvascular obstruction after primary percutaneous coronary intervention[J]. Int J Cardiovasc Imaging, 2010, 26(1): 49-55.
[25]
Ganame J, Messalli G, Dymarkowski S, et al. Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction[J]. Eur Heart J, 2009, 30(12): 1440-1449.
[26]
Husser O, Monmeneu JV, Sanchis J, et al. Cardiovascular magnetic resonance-derived intramyocardial hemorrhage after STEMI: influence on long-term prognosis, adverse left ventricular remodeling and relationship with microvascular obstruction[J]. Int J Cardiol, 2013, 167(5): 2047-2054.
[27]
Hamirani YS, Wong A, Kramer CM, et al. Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis[J]. JACC Cardiovasc Imaging, 2014, 7(9): 940-952.
[28]
Garcia-Dorado D, Théroux P, Solares J, et al. Determinants of hemorrhagic infarcts. Histologic observations from experiments involving coronary occlusion, coronary reperfusion, and reocclusion[J]. Am J Pathol, 1990, 137(2): 301-311.
[29]
Thomas R, Thai K, Barry J, et al. T2-based area-at-risk and edema are influenced by ischemic duration in acute myocardial infarction[J]. Magn Reson Imaging, 2021, 79: 1-4.
[30]
Kloner RA. The importance of no-reflow/microvascular obstruction in the STEMI patient[J]. Eur Heart J, 2017, 38(47):3511-3513.
[31]
Arcari L, Cimino S, de Luca L, et al. Impact of heart rate on myocardial salvage in timely reperfused patients with ST-segment elevation myocardial infarction: new insights from cardiovascular magnetic resonance[J]. PLoS One, 2015, 10(12): e0145495.
[32]
Ma X, Wang Z, Wang J, et al. Admission heart rate is associated with coronary artery disease severity and complexity in patients with acute coronary syndrome[J]. Angiology, 2019, 70(8): 774-781.
[33]
Reindl M, Reinstadler SJ, Feistritzer HJ, et al. Heart rate and left ventricular adverse remodelling after ST-elevation myocardial infarction[J]. Int J Cardiol, 2016, 219: 339-344.
[34]
Perne A, Schmidt FP, Hochadel M, et al. Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction[J]. Herz, 2016, 41(3): 233-240.
[35]
Bulluck H, Rosmini S, Abdel-Gadir A, et al. Residual myocardial iron following intramyocardial hemorrhage during the convalescent phase of reperfused ST-segment-elevation myocardial infarction and adverse left ventricular remodeling[J]. Circ Cardiovasc Imaging, 2016, 9(10): e004940.
2022年第47卷第2期
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doi: 10.11855/j.issn.0577-7402.2022.02.0171
  • 接收时间：2021-11-08
  • 首发时间：2025-12-17
  • 出版时间：2022-02-28
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  • 收稿日期：2021-11-08
  • 录用日期：2021-12-15
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China Special Fund for Cardiovascular Disease Development(Z-2019-42-1908-2)
中华心血管病发展专项基金(Z-2019-42-1908-2)
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    1解放军医学院，北京 100853
    2解放军总医院第一医学中心心血管内科，北京 100853

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