Effect of Revascularization Timing on Vascular Revascularization Rate,Myocardial Microcirculation,Cardiac Function and Prognosis in Patients with Acute Myocardial Infarction

SUN Yali; LIU Xinyu; ZHANG Xuelian; SONG Xinyi; REN Shuhong; ZHANG Meiling

doi:10.3969/j.issn.1002-3429.2023.08.009

Abstract：Objective To investigate the effects of revascularization timing on vascular revascularization rate,myo-cardial microcirculation,cardiac function and prognosis in patients with acute myocardial infarction(AMI).Methods A to-tal of 556 patients with AMI treated from January 2019 to June 2021 were selected and divided into early stage group(n = 278)and late stage group(n =278)according to the timing of revascularization.The early stage group underwent revascular-ization within 12 to 24 h after admission,and the late stage group underwent revascularization within 24 to 72 h after admis-sion.The rate of vascular revascularization,myocardial microcirculation indicators[starting time of contrast agent perfusion(AT),time to peak perfusion(APT),peak perfusion intensity(PI),curve rise slope(β),myocardial blood flow(MBF)],myocardial injury indicators[cardiac troponin I(cTnI),myocardial creatine kinase isoenzyme(CK-MB),N-terminal pro-brain natriuretic peptide(NT-proBNP)],vascular endothelial function indicators[serum endothelial cell spe-cific molecule-1(ESM-1),endothelin-1(ET-1),nitric oxide(NO)]before treatment,at 7 d and 3 months after treatment was compared between the two groups,and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventric-ular end-systolic diameter(LVDs),left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic volume(LVESV),and left ventricular end-diastolic volume(LVEDV)]were also analyzed before treatment and at 3 months after treatment.Results The rate of vascular revascularization in early stage group(96.40%,268/278)was higher than that in late stage group(90.29%,251/278),with significant difference(P＜0.01).AT,APT,PI,β,cTnI,CK-MB,NT-proBNP,ESM-1 and ET-1 in early stage group were lower than those in late stage group at 7 d and 3 months after treat-ment,while MBF and NO were higher than those in late stage group(P＜0.01).At 3 months after treatment,LVEF in early stage group was higher than that in late stage group,while LVDs,LVDd,LVESV and LVEDV were lower than those in late stage group(P＜0.01).The incidence of major adverse cardiovascular events(MACE)at6 months after treatment in the early stage group was lower than that in the late stage group(P＜0.05).Conclusion Revascularization within12 to24 h af-ter admission can significantly increase the rate of vascular revascularization in AMI patients,improve myocardial microcircula-tion,promote myocardial damage repair,correct vascular endothelial dysfunction,accelerate cardiac function recovery,and lower the risk of major adverse cardiovascular events.