摘要
目的以心肌呈色分级(MBG)评估急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)后的心肌灌注状况。方法109例AMI患者给予急诊PCI治疗。各例于PCI后行冠状动脉造影,观察梗死相关动脉(IRA)前向血流,评估心肌灌注情况,并记录6个月心脏事件发生率。结果冠状动脉造影结果显示,无复流组(no-reflow,NR)22例患者,占所有直接PCI患者的20.2%,既往心肌梗死史和糖尿病、前壁梗死和多支血管病变的发生率方面明显多于非NR组。NR组MBG2和3级和ST段抬高下降≥50%者显著少于非NR组,根据心肌酶估测的心肌梗死范围扩大(磷酸肌酸激酶为43.45±5.34g比27.48±4.47g,P<0.05),左心室射血分数显著降低(0.39±0.11比0.62±0.13,P<0.01);NR组总死亡率较非NR组有增加趋势,但差异无统计学意义;非致死性心力衰竭(22.7%比5.7%,P<0.05)和复合终点事件(35.0%比13.8%,P<0.05)的发生率无论住院期间还是随访6个月均明显增加,而两组在不稳定型心绞痛、非致死性再次心肌梗死、缺血性靶血管重建及总的心脏性死亡的发生率方面差异无统计学意义。结论出现NR者心肌微循环灌注不良,梗死范围大,心功能降低,预后差。
Objective To evaluated the effects of myocardial reperfusion after treatment with percutaneous coronary intervention (PCI) in acute myocardial infarction using myocardial blush grade (MBG). Methods A total of 109 AMI patients underwent PCI were divided into NR (no-reflow,NR) group (22 cases) and non- NR group (87 cases) by myocardial perfusion defect score in Single-photon emission computed temography (SPECT). Thrombolysis in myocardial infarction (TIMI) grading, myocardial blush grading and SPECT was performed immediately after PCI. The incidence of NR, clinical characteristics, blush grade, ST-segment elevation, left ventricular function and cardiac events were analysed. Results The incidence of NR was 20.2% (22 cases). Compared with the non-NR group, history of previous MI, diabetes, anterior MI and multivessel disease were observed to be more in the NR group (P<0.05), thus the blush grade and ST-segment elevation resolution (≥50%) were reduced. The myocardium infarct area expanded (43.45±5.34 CK-g vs. 27.48±4.47 CK-g, P<0.05) and the LVEF was lower (0.39±0.11 vs. 0.62±0.13, P<0.01) in the NR group. Patients with NR showed a tendency to higher mortality but of no statistical significance. During the short-term hospitalization and 6-months follow-up, non-fatal heart failure (22.7% vs. 5.7%) and composite events (35.0% vs. 13.8%, P<0.05) increased significantly in the NR group than the non-NR group. There were no significant difference in the occurance unstable angina, non-fatal reinfarction and ischemic target vessel revasculization between the two groups (P>0.05). Conclusion Malperfusion in the myocardial microcirculation, larger infarct size, ventricular dysfunction and poor prognosis are found in patients with no-reflow.
出处
《中国介入心脏病学杂志》
2005年第3期163-166,共4页
Chinese Journal of Interventional Cardiology
关键词
心肌梗死
经腔血管成形术
经皮冠状动脉
心肌呈色分级
Myocardial infarction
Angioplasty, transluminal, percutaneous coronary
Myocardial blush grading
