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。     

老年急性心肌梗死患者冠状动脉支架成形术后心肌组织水平灌注的评价

目的　观察老年急性心肌梗死患者冠状动脉介入 (PCI)治疗成功后 ,即心肌梗死溶栓治疗 (TIMI)血流达到 3级时 ,校正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TIMI 3级的老年急性心肌梗死患者 4 2例 ,测定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 1h心电图ST段回落情况。　结果　按照CTFC数值的高低 ,将TIMI 3级者分为血流快、慢两组 ,快CTFC组ST段完全回落比例明显高于慢CTFC组 (5 9 3%对 2 0 0 % ,P <0 0 5 ) ;1个月后快CTFC组的室壁运动记分改善程度 (△WMSI)明显大于慢CTFC组 (1 33± 0 39对0 6 2± 0 34,P <0 0 5 ) ,CTFC与术前、术后WMSI的差值有明显的负相关 (r =- 0 80 11,P <0 0 5 ) ;慢CTFC组患者从发病到接受PCI治疗的时间明显长于快CTFC组〔(5 8± 2 6 )h对 (4 5±2 2 )h ,P <0 0 5 )。　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。     

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.     

国产替罗非班对冠脉介入术后心肌微循环再灌注的疗效

目的：观察国产替罗非班对直接经皮冠脉介入术（PCI）术后心肌微循环再灌注的疗效。方法：急性ST段抬高急性心肌梗塞（STEMI）直接PCI术病人95例，A组（45例）PCI术中给予国产替罗非班10bLg／kg的负荷量，然后以0．15μg／kg·min静脉滴注维持18h，B组（50例）术中不予替罗非班，两组患者均在PCI术后常规给予抗血小板药物口服、肝素泵人，对比给药前后的TIMI血流分级、校正的TIMI帧数（CTFC）及术前、术后ST段回落率及室壁运动记分（WMSI），围术期出血倾向。结果：A组患者治疗后TIMI血流分级、校正的TIMI帧数、ST段完全回落率明显优于B组（P〈0．05），随访1月时，两组患者WMSI、EF均有改善，但A组的wMSI较B组改善更多（P〈0．05），A组治疗期间轻微出血发生率高于B组（P〈0．05）。结论：在阿司匹林和氯吡格雷基础上早期应用替罗非班，可减少STEMI再灌注后无再流或慢血流的发生，改善心肌微循环再灌注及病人预后。     

急性心肌梗死介入治疗中应用抽吸导管对心肌再灌注的影响

目的:分析在急性ST段抬高型心肌梗死(STEMI)急诊行经皮冠状动脉介入治疗(PCI)中应用抽吸导管对心肌再灌注影响.方法:首次STEMI行PCI患者80例,随机分为试验组(41例,应用抽吸导管后再行PCI),对照组(39例,直接行PCI).比较2组术后即刻计算校正TIMI计帧数和心肌Blush分级、术中慢复流现象、心电图90 min ST段下降率.在术后24 h、1周时应用心肌声学造影计算灌注对比积分指数(CSI)、室壁运动积分指数(WMSI).结果:PCI后试验组的校正TIMI计帧数明显低于对照组,Blush分级≥2级获得率高于对照组,慢复流现象减少;再通后90 min心电图相关导联ST段下降率试验组明显大于对照组(P<0.05).同时在研究的每一个时点,试验组CSI、WMSI较对照组明显降低(P<0.05).结论:在STEMI急诊行PCI中应用抽吸导管可改善梗死相关血管前向血流情况,改善心肌再灌注,减少无复流现象.     

心电图ST段回落结合校正TIMI帧数对心肌微血管灌注的评价

目的 :探讨急性心肌梗死 (AMI)患者血管再通后心肌组织灌注的评价方法。方法 :AMI患者接受成功的冠状动脉内介入治疗后 ,检查术前及术后 1h心电图ST段回落情况 ,并在术后检测校正的TIMI帧数(CTFC) ,观察两者之间的关系。结果 :根据ST段回落程度将患者分为 3组 ,ST段完全回落组的CTFC较低 ,术后 1个月检查射血分数恢复较好 ;无ST段回落组CTFC较高 ,射血分数值较低 ;ST段部分回落组介于两者之间。结论 :CTFC是目前临床上较理想的评价心肌微血管灌注的指标之一 ,它联合心电图ST段回落可更好地预测AMI患者的危险度 ,为是否需要进一步治疗提供可靠的依据     

急性ST段抬高型心肌梗死直接PCI术后ST段回落的临床研究

目的：通过观察急性ST段抬高型心肌梗塞（STEMI）直接经皮冠状动脉介入治疗（PCI）术后,梗塞相关动脉（IRA）达心肌梗塞溶栓（TIMI）血流3级患者心电图ST段回落程度,探讨ST段回落与心肌损伤及心脏收缩功能的关系。方法：选择在发病12h内接受直接PCI治疗后TIMI血流达到3级的STEMI患者115例,PCI术前、术后行心电图检查,观察ST段回落情况,术前、后测定患者肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）及肌钙蛋白T（cTnT）,术后测定左室射血分数（LVEF）;按照ST段回落幅度（∑STR）不同,患者被分为两组：A组：∑STR〈50%,21例,为心肌灌注不良组,B组：∑STD≥50%,94例,为心肌灌注良好组;分析两组患者ST段回落程度与CK、CK-MB、cTnT及LVEF的关系。结果：（1）两组患者IRA部位、病变血管支数,PCI治疗前TIMI血流分级、cTnT水平,发病到PCI时间等差异均无显著性（P〉0.05）;（2）两组患者术前、后CK、CK-MB水平差异无显著性（P〉0.05）;（3）术后A组cTnT水平明显高于B组[（1.30±0.43）μg/L∶（1.0±0.45）μg/L,P〈0.05];（4）术后A组LVEF明显低于B组[（44.13±4.83）%∶（47.93±5.23）%,P〈0.05]。结论：急性ST段抬高型心肌梗塞直接PCI术后,TIMI血流达到3级,ST段回落良好的患者,心肌组织水平灌注程度较好,心肌损伤程度轻,左心收缩功能较好。     

冠脉内注射前列地尔对ST段抬高型心肌梗死急诊经皮冠状动脉介入效果的影响

目的探讨急诊经皮冠状动脉介入(PCI)冠脉内注射前列地尔对急性ST段抬高型心肌梗死(STEMI)患者心肌组织灌注水平和临床预后的影响。方法连续入选STEMI急诊PCI治疗的患者80例,随机分为对照组及治疗组各40例。对照组常规行PCI治疗,试验组在对照组治疗基础上开通血管后冠脉内注射前列地尔。观察两组心肌组织灌注水平及主要心血管事件(MACE)的发生情况。结果治疗组PCI术后梗死相关血管TIMI血流分级(TFG)Ⅲ级获得率及术后1 h ST段回落程度明显高于对照组,校正TIMI血流计数帧数(CTFC)显著少于对照组(P<0.05);治疗组术中慢血流和院内MACE的发生率明显少于对照组,术中无复流及30 d的MACE与对照组无统计学差异(P>0.05)。结论 STEMI患者PCI术中开通梗死相关血管后冠脉内注射前列地尔可改善心肌微循环,增加心肌灌注,减少慢血流及院内MACE。     

S T段抬高心肌梗死患者急诊PCI术后心肌再灌注的预测指标

目的：评价ST段抬高心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者急诊冠脉介入（percutaneous coronary intervention,PCI）术后心肌再灌注的预测指标。方法选择发病12 h内接受直接PCI治疗的STEMI患者176例,根据术后TIMI血流分级分为A组（TIMI 3级,灌注良好组）,B组（TIMI 0-2级,灌注不良组）。采用心电图ST段回落、心肌损伤标志物水平进行分析。结果灌注不良组患者心电图ST段术后1 h回落不佳;CK-MB水平B组明显高于A组（P＜0．01）,且峰值持续时间长;术后BNP水平B 组明显高于A 组（P＜0．05）;术后1周B组LVEF值明显低于A组（P＜0．05）。结论 ST段早期回落是STEMI患者急诊PCI术后心肌再灌注的有效预测指标,与心肌损伤标志物水平升高一致。     

PCI后TIMI血流及心电图ST段在评价STEMI患者梗死区再灌注中的价值

目的分析急性ST段抬高性心肌梗死（STEMI）患者PCI（经皮冠状动脉介入治疗）术后1周及6个月时梗死区的室壁运动情况,评价TIMI血流及ST段回落与梗死区再灌注的关系。方法选择209例行急诊PCI和56例未行急诊血运重建的急性STEMI患者（对照组）,采用二维超声心动图测定心肌梗死后1周及6个月时梗死区的室壁运动。将PCI患者分为3组,A组为PCI后TIMI血流2～3级且2h内ST段回落〉150％者;B组为PCI后TIMI血流2～3级且2h内ST段回落〈50％者;C组为PCI后TIMI血流1级且2h内ST段回落〈50％者。结果与对照组相比,A组梗死后1周及6个月梗死区的室壁运动均明显改善（P〈0．01）,B组梗死后1周梗死区的室壁运动无明显改善,6个月时梗死区的室壁运动较对照组明显改善（P〈0．01）,且与A组无统计学差异（P〉0．05）;C组梗死后1周及6个月梗死区的室壁运动均无改善（P〉0．05）。结论急性STEMI患者成功PCI后,ST段迅速回落对于判断梗死区早期再灌注具有重要的临床预测价值,而对梗死区远期再灌注的临床预测价值较小;TIMI血流对于判断梗死区远期再灌注具有重要的临床预测价值,而对梗死区早期再灌注的临床预测价值较小。     

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.     

TIMI frame count immediately after primary coronary angioplasty as a predictor of functional recovery in patients with TIMI 3 reperfused acute myocardial infarction

OBJECTIVES: The purpose of this study was to evaluate whether higher coronary blood flow, estimated by the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC), is related to better functional and clinical outcome after successful percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI). BACKGROUND: Experimental studies have found that functional recovery of the infarcted myocardium was associated with increased blood flow (reactive hyperemia) to the infarcted bed shortly after reperfusion. METHODS: We measured CTFC immediately after successful (TIMI 3) primary PTCA in 104 consecutive patients with their first AMI. Wall motion score index (WMSI) and the presence of pericardial effusion were assessed by two-dimensional echocardiography before and one month after PTCA. RESULTS: The patients were divided into two groups according to mean CTFC for corresponding coronary artery of the control group: TIMI 3 slow group (45 patients, 40 > CTFC > or = 23) and TIMI 3 fast group (59 patients, CTFC < 23). There were no significant differences in the baseline characteristics and WMSI before reperfusion between the two groups. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group (1.33 +/- 0.52 vs. 0.60 +/- 0.34, p < 0.001). Pericardial effusion and intractable heart failure were observed more frequently in the TIMI 3 slow group than in the TIMI 3 fast group (27 vs. 10%; p < 0.05, 36 vs. 17%; p < 0.05). Corrected TIMI frame count, assessed as a continuous variable, had a significant correlation with the change in WMSI (r = 0.60, p < 0.001) after adjusting for age, gender, history of hypertension, history of diabetes, elapsed time to PTCA, collateral grade, presence of antegrade flow before PTCA and number of diseased vessels. CONCLUSIONS: Lower CTFC of the infarct-related artery immediately after PTCA was associated with greater functional recovery; and hence, CTFC can predict clinical and functional outcome in patients with successful PTCA.     

辛伐他汀对急性心肌梗死冠状动脉经皮介入治疗后心肌血流灌注的影响

目的 探讨辛伐他汀对急性心肌梗死患者急诊冠状动脉经皮介入治疗术后心肌血流灌注的影响.方法 81例行急诊冠状动脉经皮介入治疗术的急性心肌梗死患者,按之前服用辛伐他汀的情况分为四组:A组15例,服用时间超过6个月;B组19例,服用时间1～6个月;C组17例,服用时间少于1个月;D组30例,未服用.比较各组校正的TIMI帧数计数(CTFC)和1 h内ST段回落情况.结果 A组和B组CTFC较D组较小(P＜0.01),且术后1 h ST段回落较D组明显(P＜0.01).结论 长期服用辛伐他汀,可有效改善急性心肌梗死患者急诊冠状动脉经皮介入治疗术后心肌血流灌注.     

急性心肌梗死直接与联合冠状动脉入治疗的比较

目的比较尿激酶静脉溶栓联合冠状动脉(冠脉)介入治疗(PCI)术与直接PCI术对急性心肌梗死(AMI)的有效性和安全性。方法64例首次ST段抬高AMI(STelevationmyocarialinfarc-tion,STEMI)患者随机分为直接PCI组(直接PCI治疗)和联合PCI组(在尿激酶静脉溶栓基础上联合直接PCI治疗)。PCI术治疗前后行冠脉造影、心电图检查,观察梗死相关血管(IRA)前向血流,测定心肌梗死溶栓治疗临床试验(TIMI)血流、TIMI心肌灌注分级(TMPG),计算冠脉造影灌注积分(APS)和心电图ST段回落程度,评估心外膜血管和心肌灌注情况,对两组患者介入术前IRA通畅率、住院期间出血并发症、急性缺血事件发生率及出院前左心室功能进行比较。用线性回归分析评价ST段回落程度与APS的相关性。结果PCI术前联合PCI组冠脉再通率显著高于直接PCI组(68.8%比37.6%,P<0.05),其中完全再通率在两组间比较差异有统计学意义(46.9%比21.9%,P<0.05);联合PCI组心肌再灌注率显著高于直接PCI组(71.9%比37.4%,P<0.01),其中完全心肌再灌注率在两组间比较差异有统计学意义(46.9%比21.9%,P<0.05)。PCI术后两组IRA的TIMI血流3级比较差异无统计学意义(90.6%比87.5%,P>0.05),但比较TMPG差异有统计学意义(93.8%比75.0%,P<0.05),其中TMP3级有明显差异(65.6%比37.5%,P<0.05);联合PCI组APS10~12分(心肌完全再灌注)与直接PCI组比较差异有统计学意义(P<0.01)。介入治疗后出院前联合PCI组的LVEF值明显大于直接PCI组。联合PCI组ST段完全回落比例明显高于直接PCI组。线性回归分析评价ST段回落程度与APS之间有显著相关性(相关系数r=0.961,P<0.001),住院期间两组均无死亡病例、严重出血及急性缺血事件发生。结论联合PCI术较直接PCI术可获得更好的IRA开通、心肌组织和微循环灌注及心功能的明显改善。APS结合TIMI血流分级和TMPG可较好地完整评价心外膜血管和心肌灌注情况,并与心电图ST段回落程度有显著相关性。     

Normalisation of elevated ST segment predicts return of left ventricular systolic function and improved outcome in patients with acute myocardial infarction, treated with primary coronary angioplasty

BACKGROUND: It has been shown that normalisation of elevated ST segment after primary percutaneous coronary interventions (PCI) is associated with the achievement of reperfusion at the tissue level. AIM: To assess prospectively the return of left ventricular (LV) systolic function and the outcome of patients with acute myocardial infarction (AMI), treated with primary PCI, in relation to the early normalisation of the ST segment. METHODS: The study group consisted of 110 consecutive patients (33 females, 77 males, mean age 56 years) with AMI who were successfully treated with primary PCI (TIMI flow grade 3 and residual stenosis <30%) within 12 hours from the onset of symptoms. The patients were divided into two groups according to normalisation or lack of normalisation of an elevated ST segment. The mean time from the onset of symptoms to the restoration of blood flow in an infarct-related artery (pain-to-balloon time) was similar in both groups. LV echocardiographic parameters (ejection fraction EF and wall motion score index WMSI) and clinical status directly after PCI as well as 3 and 6 months later were assessed. RESULTS: Directly after primary PCI, LV impairment (low EF and high WMSI) was significantly more often present in patients without rather than with ST segment normalisation. Afterwards, LVEF and WMSI improved significantly only in patients with ST segment normalisation whereas in the remaining patients no such improvement was observed. During 6-month follow-up period, major cardiac events (death, new AMI or need for revascularisation) occurred more frequently in patients without rather than with ST segment normalisation (p=0.03). CONCLUSIONS: 1. Rapid resolution of ST segment elevation following effective primary PCI identifies patients with a favourable outcome. 2. ST segment normalisation predicts a return of LV systolic function in patients with AMI treated with primary PCI.     

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。     

盐酸替罗非班对急性ST段抬高型心肌梗死患者急诊冠状动脉介入术心肌灌注的影响

目的:探讨盐酸替罗非班对急性ST段抬高型心肌梗死(STEMI)患者行急诊冠状动脉介入术(PCI)后心肌组织的再灌注影响。方法:符合STEMI入选标准的患者69例,随机分为治疗组(32例)和对照组(37例)。治疗组术前常规给予低分子肝素、阿司匹林、氯吡格雷、调脂药等治疗,术中加用盐酸替罗非班以输液泵持续泵入;对照组除未加盐酸替罗非班外,其他治疗同治疗组。2组术中都常规应用普通肝素。联合应用TMP(TIMI myocardial perfusion)和sumSTR(sum-ST-segment resolution)方法对心肌组织的灌注进行评价。结果:2种评价方法均显示治疗组急诊PCI后心肌组织的再灌注优于对照组(均P<0.05)。结论:盐酸替罗非班能明显改善STEMI患者急诊PCI后心肌组织的再灌注水平。