急性心肌梗死后心肌存活性的相关影响因素分析

目的探讨急性心肌梗死后影响患者心肌存活性的临床相关因素。方法采用回顾性对比研究的方法,104例急性心肌梗死患者以99Tcm-MIBI SPECT静息显像及18F-FDG SPECT心肌代谢显像的检查结果分为梗死区心肌有存活组和无存活组,对比两组患者病史及各项临床特点并进行统计学分析。结果与梗死区无存活心肌组相比,梗死区仍有心肌存活组患者ECG表现ST段抬高的导联数较少(4.30±1.63vs5.22±1.97,P=0.025),ST段抬高总数值较低(0.93±0.64vs1.42±1.17,P=0.028),经皮冠状动脉介入治疗(PCI)开通梗死相关冠脉(IRA)距症状开始时间在6小时以内的患者比例较大(68.9%vs41.2%,P=0.021),PCI前冠脉血流TIMI0或1级的人数比例较低(57.7%vs88.2%,P=0.003),侧支循环0级患者比例较少(44.4%vs70.6%,P=0.024),两组差别具有统计学意义。结论心电图ST段抬高导联数及ST段抬高总数值、症状距IRA开通时间、PCI前冠脉血流TIMI分级及侧支循环分级是与急性心肌梗死后心肌存活相关的临床因素。

Factors related to the myocardial viability after acute myocardial infarction

Objective To investigate the clinical factors related to the myocardial viability after acute myocardial infarction(AMI). Methods One hundred and four AMI patients undergoing ⁹⁹Tc^m-MIBI SPECT imaging and ¹⁸F-FDG SPECT imaging were retrospectively analyzed. All the patients were divided into the viable group and nonviable group according to the findings of nuclear imaging. The clinical parameters between the two groups were compared. Results Compared with those in the nonviable group, the numbers of ST-segment elevation leads were less in the viable group (4.30±1.63 vs 5.22±1.97, P=0.025), the total volume of ST-segment elevation was lower (0.93±0.64 vs 1.42±1.17, P=0.028); the incidence of TIMI flow grade 0 or 1 of IRA showed by coronary angiography (CAG) was less (57.7% vs 88.2%, P=0.003), the ratio of collateral circulation grade 0 was less (44.4% vs 70.6%,P=0.024) and that of the time within 6 hours between the on-set of chest pain to PCI was more (68.9% vs 41.2%,P=0.021). All the above parameters between the two groups were significantly different. Conclusion The clinical factors including the lead numbers and the total volume of ST-segment elevation, the time from on-set of chest pain to PCI, the TIMI flow grade of IRAand the collateral circulation grade are closely related to the myocardial viability after AMI.