心肌呈色分级评价急性心肌梗死溶栓疗法的疗效

目的以心肌呈色分级(MBG)评估急性心肌梗死溶栓后的心肌灌注状况.方法89例急性心肌梗死患者给予重组组织型纤溶酶原激活剂治疗.各例于给药后90分钟行冠状动脉造影,观察梗死相关动脉前向血流,评估心肌灌注情况,并记录6个月心脏事件发生率.结果溶栓后符合临床再通标准的为87.6%,未再通的为12.4%.冠状动脉造影结果显示,全组梗死相关动脉的再通率(TIMI 2或3级)为82%;心肌再灌注率(MBG 2或3级)为88.8%,完全再通(TIMI 3级)且完全心肌再灌注(MBG 3级)者为40.4%.6个月死亡率为10.1%.多因素分析结果表明,入院时Killip分级和MBG分级是急性心肌梗死死亡的主要独立预测因子(P=0.0001).结论成功的再灌注治疗应该是梗死相关动脉前向血流TIMI 3级且伴良好心肌灌注.

Myocardial reperfusion evaluated by myocardial blush grade after thrombolysis in acute myocardial infarction

Objective Myocardial blush grade (MBG) as a new angiographic parameter was used to describe the effectiveness of myocardial reperfusion in patients treated with thrombolysis for acute myocardial infarction (AMI) Methods Eighty nine patients received a small dose alteplase 50mg within 12 hours of acute infarction Coronary angiography was performed at 90 min after the initiation of thrombolytic therapy to evaluate infarct related artery (IRA) patency and myocardial reperfusion Cardiac events during a 6 month period were recorded Results There were 87 6% and 12 4% patients with and without successful clinical recanalization after thrombolysis respectively Coronary angiography showed that 82 6% patients with TIMI flow 2 or 3, 88 8% patients with MBG 2 or 3, and 40 4% patients with TIMI flow 3 and MBG 3 Mortality at follow up was 10 1% Multivariate analysis showed that the MBG and Killip grade at admission were major significant predictors of 6 month mortality Conclusion The primary objective of reperfusion therapies is not only restoration of blood flow in the epicardial coronary artery, but also complete reperfusion of the infarcted myocardium