关键词: 急性心肌梗死, 经皮冠状动脉介入治疗, 心肌声学造影, 冠脉微循环灌注, 左室功能, 动态变化

Abstract: Background Although percutaneous coronary intervention（PCI） is capable of successfully opening the occluded vessels beneath the epicardium in patients with acute myocardial infarction（AMI）, a considerable proportion of patients still experience coronary microvascular dysfunction（CMD） after the procedure, and this significantly affects the recovery of long-term cardiac function. Nevertheless, the dynamic change trends of early microcirculation perfusion after interventional therapy on cardiac function at different periods remain undefined. Objective To examine the influence of early coronary microcirculation perfusion following percutaneous coronary intervention (PCI) on left ventricular remodeling and functional changes at different postoperative time points in patients with acute myocardial infarction (AMI). Methods A total of 98 patients with acute myocardial infarction (AMI) who successfully underwent percutaneous coronary intervention (PCI) were divided into two groups based on myocardial contrast echocardiography (MCE) findings obtained 2 to 7 days postoperatively: the normal coronary microcirculation perfusion (NOR) group (n = 41) and microvascular perfusion abnormalities (MPA) group (n = 57). Echocardiographic assessments of left ventricular systolic and diastolic function were performed at baseline, 2 months, and 12 months postoperatively. Clinical data from both groups were collected and subjected to statistical analysis. Results Compared with the NOR group, patients in the MPA group exhibited significantly elevated BNP levels (P < 0.001), a significantly lower proportion of preoperative standardized medication use (P = 0.025), a significantly higher proportion of ST-segment elevation myocardial infarction (STEMI) (P = 0.032), and culprit vessels predominantly located in the left anterior descending artery (LAD) (P < 0.001). Compared with the NOR group, the MPA group exhibited significantly lower absolute values of LVEF and GLS at 2-7 days, 2 months, and 12 months postoperatively. Additionally, LVIDd, LVIDs, and LAD were significantly larger in the MPA group. Furthermore, the E/e' ratio at 12 months postoperatively was significantly higher in the MPA group (P < 0.05). Compared with the 2-7 days postoperative period, both groups of patients exhibited significant improvements in LVEF and GLS at 2 months and 12 months after PCI. Additionally, LVEDV and LVESV were significantly reduced during these follow-up periods (P < 0.05). Spearman correlation analysis revealed that early microcirculation perfusion after PCI was significantly negatively correlated with LVEF changes from 2-7 days to 12 months postoperatively (r = -0.305, P = 0.019) and from 2 months to 12 months postoperatively (r = -0.279,P = 0.034). In contrast, it was significantly positively correlated with LVEF changes from 2-7 days to 2 months postoperatively (r = 0.276, P = 0.019). Results of univariate and multivariate analyses showed that LVEF (2-7 days after PCI) and myocardial perfusion were independent risk factors for changes in left ventricular function at 12 months after PCI in AMI patients. Conclusions The early microcirculation perfusion level following PCI in patients with acute myocardial infarction is associated with subsequent left ventricular functional alterations. Patients with poor early microcirculation perfusion exhibit poorer left ventricular systolic function. Even if there is a marked improvement in the short term, the long-term recovery remains unsatisfactory.

Key words: Acute Myocardial Infarction（AMI）, Percutaneous Coronary Intervention（PCI）, Myocardial Contrast Echocardiography（MCE）, Coronary Microcirculation Perfusion, Left Ventricular Function, The Dynamic Change