超选择性冠脉内注射硝普钠对急性心肌梗死急诊冠状动脉介入治疗中无再流现象的作用

目的:评价超选择性冠状动脉内注射硝普钠对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入(PCI)治疗中梗死相关动脉(IRA)无复流现象的作用。方法:选择AMI急诊PCI后再通的IRA存在无复流现象者43例。21例患者经血栓抽吸导管超选择性梗死相关冠状动脉内注射法,22例患者采用常规指引导管内注射方法。药物均采用硝普钠100μg,2 s内"弹丸式"快速注射完毕。10 min后复查冠状动脉造影,评定冠状动脉血流TIMI分级及校正TIMI帧数(cTFC)。结果:两组均可明显改善急诊PCI后的无再流现象,超选择组所有患者梗死相关血管IRA血流恢复TIMIⅢ级,cTFC帧数由用药前的(84±7)帧降至(26±6)帧,与常规组相比较差异有统计学意义(P0.01)。结论:超选择性IRA内快速注射硝普钠100μg能更有效地改善AMI急诊PCI中无再流现象。     

地尔硫卓治疗直接经皮冠状动脉介入术无复流的临床研究

目的探讨冠状动脉内注射地尔硫卓治疗直接经皮冠状动脉介入术（PCI）无复流的疗效。方法对23例直接PCI无复流患者给予梗死相关冠脉（IRA）内推注地尔硫卓2-4mg,分别于推注地尔硫卓前及推注后5min,用校正的心肌梗死溶栓治疗临床实验（TIMI）帧数（Corrected TIMI FrameCount,CTFC）评价IRA血流情况。结果23例无复流患者于IRA内注入地尔硫卓后CTFC由（60.45±12.10）帧降至（30.03±8.20）帧（P〈0.001）,其中17例（复流组）IRA血流恢复至TIMI3级,6例（无复流组）IRA血流未恢复,有效率73.91%。结论冠脉内注射地尔硫卓治疗直接PCI无复流能有效地恢复患者IRA血流,可作为治疗无复流的一种方法。     

冠状动脉靶病变远端经微导管注射硝普钠对冠状动脉介入治疗中无复流的作用

目的评价冠状动脉靶病变远端经微导管注射和直接冠状动脉内注射硝普钠对经皮冠状动脉介入（ percutaneous coronary intervention, PCI） 治疗中“无复流”的作用。方法选择PCI治疗中存在“无复流”现象的患者56例为研究对象,其中21例入选普通组,经指引导管冠状动脉内注射硝普钠200斗g;23例入选改良组,经微导管注射硝普钠至靶病变远端：12例为对照组,经微导管注射O．9％氯化钠溶液至靶病变远端。10min后复查冠状动脉造影。评定冠状动脉血流心肌梗死溶栓试验（thrombolysis in myocardial infarction, TIMI）分级及校正TIMI帧数（corrected tbrombolysis in myocardial infarction framecount, CTFC）。结果3组均可改善PCI治疗后的“无复流”现象。普通组12例靶血管血流恢复TIMI3级,CTFC帧数由用药前的（83．2±8．3）帧降至（38．1±7．5）帧;而改良组21例血流恢复TIMI3级,CTFC帧数从（85．6±6．9）帧降至（27．3±6．8）帧;对照组1例血流恢复TIMI3级,CTFC帧数从（84．3±7.4）帧降至（50．8±8．2）帧。改良组疗效明显优于普通组和对照组,差异有统计学意义（P（0．01）。结论PCI治疗中,冠状动脉靶病变远端经微导管注射和经指引导管冠状动脉内注射硝普钠均能改善“无复流”现象。经微导管注射硝普钠至靶病变远端比经指引导管注射能更有效地改善PCI治疗中“无复流”现象。     

Clinical significance of intra-aortic balloon pumping on no-reflow phenomenon of primary percutaneous coronary intervention for acute myocardial infarction

Background Percutaneous coronary intervention(PCI) is used as a treatment for acute myocardial infarction(AMI),and one of its major complications is the angiographic no-reflow phenomenon(NR).Although intra-aortic balloon pumping(IABP) is sometimes used in such patients to increase the diastolic coronary blood flow,there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon.Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 a...     

校正的TIMI帧数评价急性心肌梗死血管成形术后心肌组织灌注

目的观察急性心肌梗死患者经皮冠状动脉介入(PCI)治疗成功后,即TIMI血流达到3级时,用校正的TIMI帧数(CTFC)评价心肌组织水平灌注的可行性.方法选取急性心肌梗死患者急症PCI治疗后血流达TIMI 3级者63例,其中男45例,女18例.测定患者的CTFC,并在术前及术后1个月分别测定室壁运动记分(WMSI).观察CTFC与WMSI之间的相关性.结果按照CTFC将TIMI血流3级者分为快、慢两组,1个月后快CTFC组的WMSI改善程度明显优于慢CTFC组,CTFC与术前、术后WMSI的差值有明显的负相关;快CTFC组患者从发病到接受PCI治疗的时间明显短于慢CTFC组.结论较低的CTFC预示着良好的心功能恢复及临床预后,它是一种定量、客观、简单、经济、重复性好的方法,用其评价心肌循环灌注情况可为临床提供是否需要进一步辅助治疗的证据.     

Treatment of slow/no-reflow phenomenon with intracoronary nitroprusside injection in primary coronary intervention for acute myocardial infarction.

Slow/no-reflow phenomenon is a serious problem complicating primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and is associated with a poor prognosis. From January 2002 to November 2002, 11 of the 70 consecutive patients with ST elevation AMI who were subjected to primary PCI using balloon angioplasty and/or stenting developed slow/no-reflow phenomenon (TIMI 1 flow in 2, TIMI 2 in 8, and TIMI 2.5 in 1). They were 10 men and 1 woman, aged 64 +/- 11 years (range, 46-81). The culprit vessels were six in the left anterior descending coronary artery, three in the right coronary artery, one in the left circumflex coronary artery, and one in saphenous vein graft. Multiple bolus doses (100 microg) of nitroprusside were injected into the index artery through the guiding catheter using a 3 ml syringe until the TIMI flow grade improved by at least one grade or the systolic pressure decline below 80 mm Hg (one patient). The total drug dose varied from 100 to 700 microg. Following the drug treatment, angiographic TIMI flow grade improved by at least one grade in 9 (82%) of the 11 patients (P = 0.007). The TIMI frame counts significantly decreased from 36 +/- 17 frame counts to 16 +/- 11 frame counts (P = 0.012). All patients were discharged without major adverse cardiovascular events. Intracoronary bolus injection of nitroprusside using a 3 ml syringe appears to be a feasible, safe, and effective technique for the management of slow/no-reflow phenomenon complicating primary PCI.     

hs-CRP is a potential predictor of no-reflow in patients with AMI after emergency PCI

The paper aims to determine whether the inflammation,a powerful risk factor that has been demonstrated for the development of coronary artery disease,plays a role in no-reflow phenomenon in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Methods We prospectively analyzed 656 patients with AMI after primary PCI.Based on post-PCI angiography data,patients were divided into two groups:the no-reflow group (TIMI=2,n =60) and the reflow group (TIMI=3,n =596).Results Our results showed that the inflammatory factors including leukocyte count (×109/L) (10.90±4.04 vs.9.12±2.98 P =0.002),hs-CRP (5.04±0.71 vs.4.70±0.75 P =0.001) and other factor platelet count (×109/L) (210.96±33.42 vs.196.41±46.06 P =0.033) in no-reflow group are significantly higher than those in reflow group,major adverse cardiac events happened in the patients with no-reflow are higher than in reflow patients no matter in hospital or at the end of follow-up.We also found the left ventricular ejection fraction (LVEF) dramatically decreased (58.65±9.34 vs.51.29±11.38,P＜0.001) and left ventricular end-diastolic dimension (LVEDD) significantly increased (49.94±6.75 mm vs.54.66±6.68mm,P＜0.001) in no-reflow patients at the end of follow-up.Conclusions Our results suggest that inflammation factors function in no-reflow phenomenon,and no-reflow is a serious complication after primary PCI which predicts poor left ventricular systolic functional recovery and mortality in patients with AMI.(J Geriatr Cardiol 2008;5:217-222)     

急性ST段抬高心肌梗死患者急诊经皮冠状动脉介入治疗无复流现象相关因素分析

目的探讨急性ST段抬高心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）中出现无复流的相关危险因素。方法选取发病在12h内的1059例STEMI患者给予急诊PCI,收集患者的临床、造影和介入治疗资料。PCI术后,根据心肌梗死溶栓（TIMI）分级和校正TIMI帧数将患者分为正常血流组和无复流组。比较两组患者的基本临床资料、造影结果和手术相关资料的差异,分析STEMI患者急诊PCI术中出现无复流的原因。结果急诊PCI术中无复流组患者118例。正常血流组941例,无复流发生率为11．14％。研究共纳入63个指标,通过单变量分析发现,年龄、症状至PCI时间、谷草转氨酶、氯吡格雷使用情况、干预病变数、狭窄程度及血栓负荷与急诊PCI术中发生无复流具有相关性（P〈0．05）。多变量Logistic回归模型认为,年龄（OR=1．04,95％CI：1．02—1．06）与血栓负荷（OR=1．72,95％CI：1．07～2．76）可作为预测急诊PCI术中无复流发生的独立危险因素。结论年龄与血栓负荷可作为预测急性STEMI患者急诊PCI术中发生无复流的独立危险因素,而糖尿病、高血压、高血脂、吸烟等冠心病的传统危险因素与无复流未见相关性。     

前列地尔对改善急性心肌梗死PCI术后微循环及患者预后的影响

目的:探讨前列地尔治疗急性心肌梗死经皮冠状动脉介入术(PCI)治疗后微循环障碍以及改善患者预后的临床效果。方法:将57例因ST段抬高型急性心肌梗死接受急诊PCI的患者随机分为2组,前列地尔组在术前30 min使用前列地尔注射液治疗,并在术后继续治疗7 d。通过检测校正的TIMI帧数计数(CTFC)、心肌声学造影(MCE)等多种方法评估心肌灌注,并观察患者在住院和随访期间心功能情况及主要心脏不良事件。结果:前列地尔组术后的TIMI 3级血流发生率明显高于对照组(P=0.038),术后CTFC值也较对照组明显升高(P0.001);在治疗6个月后前列地尔组的左室射血分数(LVEF)、舒张早期充盈最大速率(E峰)与心房收缩期最大充盈速率(A峰)的比值(E/A)、左室舒张末期内径(LVEDD)以及左室收缩末期内径(LVESD)均较治疗3 d后有明显改善(P均0.05),而室间隔厚度(IVST)以及左室后壁舒张末期厚度(LVPWD)则无明显变化;两组患者PCI术后48 h、术后7 d的MCE显示,前列地尔组的局部心肌血流量在术后7 d有显著升高(P0.05)。对照组在住院和随访期间发生6例严重心力衰竭以及1例死亡病例,前列地尔组在住院期间发生严重心力衰竭1例,在随访期间发生严重心力衰竭1例,无死亡病例,两组比较无统计学差异。结论:前列地尔可以有效地改善PCI术后的心脏血流灌注,减少无复流现象的发生,可能改善急性心肌梗死患者心功能及临床预后。     

急性冠状动脉支架成形术后心肌组织灌注的临床研究

目的 观察急性心肌梗死患者冠状动脉介入(PCI)治疗成功后，校正的TIMI帧数(CTFC)与心电图ST段回落联合评价心肌组织水平灌注的可行性。方法 测定PCI治疗后血流达。TIMI3级患者的CTFC，并在术前及术后1个月分别测定室壁运动记分(WMSI)。观察CTFC与WMSI之间的相关性，同时检查术前及术后1小时心电图ST段回落情况。结果 按照CTFC将，TIMI血流3级者分为快、慢两组，快CTFC组患者ST段回落程度明显优于慢CTFC组；1个月后快CTFC组患者的室壁运动记分改善程度明显优于慢CTFC组，CTFC与术前、术后WMSI的差值有明显的负相关；快CTFC组患者从发病到接受PCI治疗的时间明显短于慢CTFC组。结论 CTFC作为一种定量、客观、简单、经济、重复性好的方法评价心肌微循环灌注情况，较低的CTFC及心电图ST段回落完全预示着良好的心功能恢复，可为临床提供是否需要进一步辅助治疗的证据。     

校正TIMI帧数与ST段回落评价老年急性心肌梗死患者支架成形术后心肌组织灌注

目的　观察老年急性心肌梗死 (AMI)患者冠状动脉介入 (PCI)治疗成功后 ,校正的 TIMI帧数 (CTFC)与心电图 ST段回落联合评价心肌组织水平灌注的可行性。方法　选取接受 PCI治疗后血流达 TIMI3级的老年 AMI患者 42例 ,测定 CTFC,并在术前及术后 1月分别测定室壁运动记分 (WMSI)。观察 CTFC与 WMSI之间的相关性 ,同时检查术前及术后 1 h心电图 ST段回落情况。结果　按照 CTFC将 TIMI血流 3级者分为快、慢两组 ,快 CTFC组 ST段回落程度明显优于慢 CTFC组 ;一个月后快 CTFC组的 WMSI改善程度明显优于慢 CTFC组 ,CTFC与术前、术后WMSI的差值有明显的负相关 ;快 CTFC组患者从发病到接受 PCI治疗的时间明显短于慢 CTFC组。结论　 CTFC作为一种定量、客观、简单、经济、重复性好的方法评价心肌微循环灌注情况 ,较低的 CTFC及心电图 ST段回落完全预示着良好的心功能恢复及临床预后 ,可为临床提供是否需要进一步辅助治疗的依据。     

A pilot study with a new, rapid-exchange, thrombus-aspirating device in patients with thrombus-containing lesions: the Diver C.E. study.

BACKGROUND: In patients with acute coronary syndromes (ACS), distal embolization of thrombotic material is more likely to play a key role in the pathogenesis of myocardial no-reflow during percutaneous coronary intervention (PCI). Thus, interventional techniques able to reduce thrombus burden at the culprit vessel might improve final myocardial reperfusion. OBJECTIVE: To evaluate a new rapid-exchange thrombus-aspirating catheter, the Diver C.E., in patients with thrombotic coronary lesions undergoing PCI. METHODS: Fifty patients with acute myocardial infarction (n = 44) or with non-ST-elevation ACS and angiographic evidence of coronary thrombus (n = 6) undergoing urgent PCI were prospectively enrolled. The Diver C.E. was used to aspirate coronary thrombus from the culprit lesion after placement of the guidewire. Adjunctive balloon inflations and stent implantation were used to achieve good angiographic result. Angiographic coronary flow (by means of TIMI score and corrected TIMI frame count, cTFC), thrombus score (TS), and myocardial perfusion (by means of postintervention myocardial blush grade, MBG) were assessed in all patients. RESULTS: The device could be successfully employed in 96% of the cases (48/50) and yielded significant (P < 0.0001) acute reduction in thrombus burden (TS: predevice 3.5 +/- 0.8, postdevice 2.5 +/- 0.9) and improvement in coronary flow (TIMI grade: predevice 1.0 +/- 0.9, postdevice 2.0 +/- 0.9; CTFC predevice 71 +/- 31, postdevice 39 +/- 26). Final TIMI grade 0-1 was observed in one patient only (2%). A significant (P = 0.02) correlation was found between preintervention TS and efficacy of thrombus aspiration. A more pronounced acute reduction of thrombus burden after thrombus aspiration (TS reduction > or = 2) was associated with a better postintervention angiographic myocardial perfusion (MBG 2.3 +/- 0.9 vs 1.7 +/- 0.8; P = 0.05). CONCLUSIONS: This new, easy-to-use, device is able to reduce thrombus burden and to improve coronary flow in patients with thrombus-containing lesions. The improvement in myocardial perfusion associated to greater thrombus removal highlights the importance of thrombus aspiration in the management of thrombus-burdened coronary lesions.     

Endothelin-1 and acute myocardial infarction: a no-reflow mediator after successful percutaneous myocardial revascularization.

AIMS: No-reflow after a primary percutaneous coronary intervention (PCI) is associated with a high incidence of left ventricular (LV) failure and a poor prognosis. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and an important modulator of neutrophil function. Elevated systemic ET-1 levels have recently been reported to predict a poor prognosis in patients with acute myocardial infarction (AMI) treated by primary PCI. We aimed to investigate the relationship between systemic ET-1 plasma levels and no-reflow in a group of AMI patients treated by primary PCI. METHODS AND RESULTS: A group of 51 patients (age 59+/-9.9 years, 44 males) with a first AMI, undergoing successful primary or rescue PCI, were included in the study. Angiographic no-reflow was defined as coronary TIMI flow grade < or =2 or TIMI flow 3 with a final myocardial blush grade < or =2. Blood samples were obtained from all patients on admission for ET-1 levels measurement. No reflow was observed in 31 patients (61%). Variables associated with no-reflow at univariate analysis included culprit lesion of the left anterior coronary descending artery (LAD) (67 vs. 29%, P=0.006) and ET-1 plasma levels (3.95+/-0.7 vs. 3.3+/-0.8 pg/mL, P=0.004). At multivariable logistic regression analysis, ET-1 was the only significant predictor of no-reflow (P=0.03) together with LAD as the culprit vessel (P=0.04). CONCLUSION: ET-1 plasma levels predict angiographic no-reflow after successful primary or rescue PCI. These findings suggest that ET-1 antagonists might be beneficial in the management of no-reflow.     

冠状动脉内单用替罗非班与联合应用山莨菪碱对急性心肌梗死经皮冠状动脉介入治疗后无再流现象影响的对比研究

目的:探讨冠状动脉内联合应用山莨菪碱和替罗非班对逆转急性心肌梗死(AMI)介入治疗后无再流的可行性、安全性及临床疗效。方法:行冠状动脉介入治疗的AMI患者252例,发生无再流47例,随机分为A组(替罗非班组)和B组(盐酸山莨菪碱联合替罗非班组),观察冠状动脉内SBP、DBP、MBP、HR、肺毛细血管楔压(PCWP)、左室舒张末期压力(LVEDP)、TIMI血流及TIMI血流计帧数的变化以及住院期间及术后1个月的主要心脏不良事件发生率。结果:A组冠状动脉内用药后SBP、DBP、MBP、HR、LVEDP及PCWP无明显变化,而B组用药后冠状动脉内SBP、DBP、MBP、HR明显升高(P<0.05或P<0.01),LVEDP及PCWP降低,但与用药前及A组比较差异无统计学意义;2组均明显改善TIMI血流及TIMI血流计帧数,B组效果更明显,均P<0.01。2组住院期间及术后1个月均无死亡、再次心肌梗死、再次血运重建、心绞痛等主要心脏不良事件发生。结论:冠状动脉内联合应用盐酸山莨菪碱和替罗非班可显著逆转AMI后无再流,不增加恶性心律失常和出血并发症的发生。     

Relation of corrected thrombolysis in myocardial infarction frame count and ST‐segment resolution to myocardial tissue perfusion after acute myocardial infarction

Objectives : To evaluate myocardial tissue perfusion by corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) and ST‐segment resolution after successful percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Background : Early and sustained potency of infarct‐related artery (IRA) has become the main goal of reperfusion therapy in patients with AMI. However, myocardial tissue perfusion may remain impaired even after the achievement of TIMI grade 3 flow of the epicardial artery without residual stenosis. Methods : CTFC was measured after successful PCI in 63 patients with first AMI. The extent of ST‐segment resolution was recorded 1 hr after reperfusion therapy. The wall motion score index (WMSI) was assessed before and 1 month after PCI. Then we studied the correlation between CTFC, ST‐segment resolution, and WMSI. Results : According to CTFC, the patients with TIMI grade 3 flow after PCI were divided into two groups: CTFC fast group and CTFC slow group. CTFC fast group had higher percentage of complete ST resolution (54.1% vs. 25.0%, P < 0.05) and lower percentage of no ST resolution (2.6% vs. 29.2%, P < 0.05). Improvement of WMSI in the CTFC fast group was significantly greater than that of the CTFC slow group (1.30 ± 0.41 vs. 0.64 ± 0.30, P < 0.05). CTFC had a significant negative correlation with the change in WMSI (r = ?0.75, P < 0.01). Conclusions : Combined with ST‐segment resolution, CTFC could predict risk for patients with successful reperfusion therapy after AMI and provide evidence for additional adjunctive treatment. © 2008 Wiley‐Liss, Inc.     

急性心肌梗塞前心绞痛对其急诊冠脉介入术后再流现象的影响

目的:探讨梗塞前心绞痛(PIA)对急性心肌梗塞(AMI)患者经皮冠状动脉介入治疗(PCI)后无再流现象的影响。方法:230例行急诊PCI的AMI患者依其是否发生再流现象分为两组:无再流组(25例)和再流组(205例)。监测再灌注心律失常、心肌酶谱和C反应蛋白(CRP)变化;超声心动图测定心功能,观察室壁瘤、心力衰竭发生率和住院病死率。结果:无再流组PIA发生率显著低于再流组(P<0.01);而前壁梗塞的发生率高于再流组(P<0.01),CRP值明显高于再流组(P<0.05);再灌注心律失常发生率、肌酸激酶同工酶峰值和水平均显著高于再流组(P<0.01)。左室射血分数显著低于再流组(P<0.05);心力衰竭、室壁瘤发生率和死亡率均高于再流组(P<0.01)。而多元回归分析结果显示,缺乏PIA是发生无再流现象的独立预测因素(OR=3.71,P=0.01)。结论:缺乏PIA是发生无再流现象的独立预测因素。     

经两种导管注射地尔硫卓处理急诊PCI术中无复流现象的疗效比较

目的:观察急诊经皮冠状动脉介入治疗(PCI)术中出现无复流现象后,经微导管向远端血管床注射地尔硫卓的治疗效果。方法:选择PCI治疗中存在“无复流”现象的患者41例为研究对象,其中20例入选导引导管组,经导引导管冠状动脉内注射地尔硫卓2.0 mg;21例入选微导管组,经微导管注射地尔硫卓2.0 mg至靶病变远端:10 min后复查冠状动脉造影,观察两组患者首次和手术结束前末次造影图像,评定冠状动脉血流心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)分级及TIMI心肌组织灌注分级(TMPG)、1周内住院期间主要心脏不良事件(MACE)事件。结果:2组均可改善PCI治疗后的“无复流”现象。微导管组手术结束前末次造影TIMIⅢ级比例明显高于导引导管组[95%(20/21)vs.40%(8/20),P<0.05],而且手术结束前末次造影TIMI心肌组织灌注分级(TMPG)Ⅲ级亦较高(90%vs.35%,P<0.05),减少1周内住院期间MACE事件(5%vs.30%,P<0.05)。结论:与经导引导管相比,经微导管注射地尔硫卓明显改善急诊PCI术中无复流现象。     

Clinical and procedural predictors of no-reflow phenomenon after primary percutaneous coronary interventions: experience at a single center.

BACKGROUND: The aim of the study was to identify clinical factors, angiographic findings, and procedural features that predict no-reflow phenomenon (Thrombolysis In Myocardial Infarction (TIMI) flow grade < or =2) in patients with acute myocardial infarction (AMI) who undergo primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: A series of 382 consecutive patients with AMI underwent primary PCI within 12 h of symptom onset. Patients with ischemic symptoms continuing for more than 12 h were also included. Clinical, angiographic and procedural data were collected for each subject. Ninety-three (24.3%) of the patients developed no-reflow phenomenon, and their findings were compared with those of the reflow group. Univariate analysis showed that advanced age (>60 years), delayed reperfusion (> or =4 h), low (< or =1) TIMI flow prior to PCI, cut-off type total occlusion, high thrombus burden on baseline angiography, long target lesion (>13.5 mm) and large vessel diameter all correlated with no-reflow (p<0.05 for all). Multiple logistic regression analysis identified that advanced age (odds ratio (OR) 1.04, p=0.001), delayed reperfusion (OR 1.4, p=0.0004), low TIMI flow before primary PCI (OR 1.1, p=0.0002), target lesion length (OR 5.1, p=0.0003) and high thrombus burden (OR 1.6, p=0.03) on angiography as independent predictors of no-reflow phenomenon. CONCLUSION: The occurrence of no-reflow phenomenon after primary PCI can be predicted using simple clinical, angiographic and procedural features. In this selected group of patients, adjunctive pharmacotherapy and/or distal protection device may be of value.     

梗死前心绞痛对急性心肌梗死患者经皮冠状动脉介入治疗术后无再流现象的影响

目的探讨梗死前心绞痛(PIA)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后无再流现象的影响。方法100例首次AMI患者均在发病12h内行PCI术。所有患者按照有无无再流现象分为2组:无再流组(15例)和再流组(85例)。监测心肌酶谱和C反应蛋白(CRP)变化;放射性核素测定心功能;观察室壁瘤、心力衰竭发生率和住院病死率。结果无再流组PIA发生率显著低于再流组(P<0.01);而前壁梗死的发生率高于再流组(P<0.05);肌酸激酶同工酶峰值和CRP水平均显著高于再流组(P<0.01)。无再流组放射性缺损面积显著大于再流组(P<0.01);左室射血分数显著低于再流组(P<0.01);心力衰竭、室壁瘤发生率和死亡率均高于再流组(P<0.05)。多元Logistic回归分析结果显示,缺乏PIA是发生无再流现象的独立预测因素(OR=6.12,P=0.01)。结论缺乏PIA是发生无再流现象的独立预测因素,而无再流现象与心力衰竭和死亡率增高密切相关。     

急性心肌梗死经皮冠状动脉介入治疗后心肌灌注的方法评价

目的　联合应用TIMI心肌灌注分级 (TMP)、校正的TIMI画面记帧 (CTFC)、心电图ST段变化 (sumSTR)方法评价急性心肌梗死 (AMI)急诊经皮冠状动脉介入治疗 (PCI)后心肌灌注程度 ,探讨心肌灌注程度对临床预后的影响。方法　 77例AMI患者PCI后即刻采用TMP CTFC、TMP sumSTR、CTFC sumSTR三种联合方法评价心肌灌注程度 ,PCI术后 1个月检查双核素心肌灌注显像 ,记录 6个月心脏事件。结果　评价心肌灌注程度 ,与双核素心肌灌注显像对比 ,TMP sumSTR敏感性 86 7%、特异性 85 7%、准确性 86 2 % ;TMP CTFC敏感性 80 %、特异性 77 1%、准确性 78 5 % ;多变量回归分析TMP 0 / 1级 sumSTR <30 %为 6个月心脏事件的独立危险因子 (OR=2 1 5 ,95 %可信区间 2 7～ 6 5 7,P =0 0 0 3) ;Kaplan Meier分析曲线显示TMP sumSTR方法评价的心肌灌注不良组 6个月心脏事件高于心肌灌注良好组 (P <0 0 5 )。结论　TMP sumSTR、TMP CTFC能更好的评价心肌灌注程度 ;TMP sumSTR可预测 6个月心脏事件。