急性心肌梗死急诊经皮冠状动脉介入治疗后评价心肌组织再灌注方法的对比研究

目的应用TIMI心肌灌注分级、单个导联ST段回落幅度、单个导联ST段最大偏移幅度和超声心动图四种方法评价急性心肌梗死急诊经皮冠状动脉介入治疗后心肌水平再灌注。方法50例急性心肌梗死患者急诊介入治疗后采用TIMI心肌灌注分级、单个导联ST段回落幅度、单个导联ST段最大偏移幅度及随访1个月超声心动图观察室壁运动改善四种方法评价心肌灌注,并于术后7±2天行核素心肌灌注显像。结果与核素心肌灌注显像比较,TIMI心肌灌注分级敏感性为94.7,特异性为16.7,准确性为76.0;单个导联ST段回落幅度敏感性为89.5,特异性为83.3,准确性为88.0;单个导联ST段最大偏移幅度敏感性为84.2,特异性为83.3,准确性为84.0;超声心动图敏感性为78.9,特异性为83.3,准确性为80.0。心电图(单个导联ST段回落幅度、单个导联ST段最大偏移幅度)和超声心动图与核素检查存在一致性,且一致性良好;TIMI心肌灌注分级未显示与核素检查存在一致性。结论心电图和超声心动图可较好地评价急性心肌梗死后心肌组织再灌注水平。

The Comparison of Methodologies of Assessing Myocardial Reperfusion in Patients with Acute Myocardial Infarction After Percutaneous Coronary Intervention

Aim To assess the predictive value of coronary angiography TIMI myocardial perfusion grade(TMPG),electrocardiogram(ECG) single-lead ST segment resolution(STR),ECG max-ST-segment deviation(MaxSTE) and echocardiography on judging myocardial reperfusion after primary angioplasty in the patients with acute myocardial infarction(AMI).Methods PCI was performed in 50 patients within 12 hours after AMI onset.Coronary angiography,ECG and echocardiography were done before or after angioplasty.TMPG,ECG single-lead STR,MaxSTE and echocardiography were used to assess myocardial reperfusion after PCI.Myocardial perfusion scan was examined in all the patients using 99mTc-MIBI SPECT on day 7±2.Results Compared with the level of myocardial perfusion demonstrated in myocardial scan of 99mTc-MIBI SPECT,the sensitivity,specificity and accuracy of TMPG,single-lead STR,MaxSTE and echocardiography were calculated.The sensitivity of TMPG,Single-lead STR,MaxSTE and echocardiography was 94.7%,89.5%,84.2% and 78.9%,respectively;the specificity of those was 16.7%,83.3%,83.3%,83.3%,respectively;the accuracy was 76.0%,88.0%,84.0% and 80.0%,respectively.The findings in single-lead STR,MaxSTE and echocardiography match well with the results of myocardial scan of 99m Tc-MIBI SPECT.Conclusion PCI,ECG and echocardiography are effective methods to assess myocardial reperfusion in the patients suffering from AMI.