组蛋白去乙酰化酶3用于急性心肌梗死经皮冠状动脉介入治疗后慢血流或无复流风险评估

目的 探讨术前组蛋白去乙酰化酶3(HDAC3)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后慢血流/无复流风险的评估价值。方法 选取2020年6月至2022年6月在唐山市工人医院接受PCI的AMI患者280例,根据PCI术后心肌灌注分级(TIMI)血流分级分为慢血流/无复流组(TIMI≤Ⅱ级)54例和正常血流组(TIMI>Ⅱ级)226例。比较2组人口学特征、基础疾病、入院时基线资料、术前冠状动脉造影结果及术前实验室指标。采用多因素logistic回归分析确定AMI患者PCI术后慢血流/无复流的影响因素,绘制ROC曲线分析相关指标对慢血流/无复流的预测价值。结果 慢血流/无复流组吸烟史、Killip分级Ⅱ级比例、心率、再灌注时间、血清低密度脂蛋白胆固醇、中性粒细胞计数/淋巴细胞比值(NLR)、D-二聚体及HDAC3水平高于正常血流组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,再灌注时间、NLR、HDAC3是AMI患者PCI术后慢血流/无复流的影响因素(P<0.05,P<0.01)。再灌注时间+NLR预...     

SYNTAX评分对急性心肌梗死患者急诊PCI术后无复流现象的预测价值

目的探讨SYNTAX评分对急性心肌梗死(AMI)患者急诊经皮冠状溶栓治疗(PCI)术后无复流现象的预测价值。方法入选2010年1月至2013年1月辽宁医学院附属第一医院心内科因AMI行急诊PCI术的患者612例,按照急诊PCI术后是否发生无复流分为无复流组(95例)与正常血流组(517例)。并搜集所有患者的临床基线资料、实验室检查、冠状动脉造影结果、手术相关资料以及SYNTAX评分进行单变量分析,再将有统计学意义的变量再纳入二分类变量Logistic回归分析模型中,应用ROC曲线评价SYNTAX评分值对AMI患者急诊PCI术后无复流发生的预测价值。结果经过单变量分析,两组患者糖尿病史、中性粒细胞计数、射血分数、梗死部位、梗死相关动脉、干预前血流TIMI分级、SYNTAX评分值、PCI术前血栓负荷分级、病灶血管长度、入院时间具有统计学意义(P<0.05);二分类Logistic回归分析示糖尿病史、中性粒细胞计数、干预前血流TIMI分级、SYNTAX评分值、PCI术前血栓负荷分级、入院时间是无复流的独立预测因素;ROC曲线下面积为0.73(95%CI:0.66⁰.80,P<0.01)。当截点值取18.3时,SYNTAX评分对AMI患者急诊PCI术后无复流预测的灵敏度和特异度分别为74.7%和70.3%。结论糖尿病史、中性粒细胞计数、干预前血流TIMI分级、SYNTAX评分值、血栓负荷分级、入院时间是AMI患者急诊PCI术后发生无复流的独立预测因素,且SYNTAX评分对无复流发生的预测价值具有较高的灵敏度和特异度。     

急诊经皮冠状动脉介入治疗术后中性粒细胞水平与心肌灌注和心功能的相关性研究

目的:评价急性ST段抬高心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后中性粒细胞水平与心肌灌注和心功能的相关性。方法:入选发病12 h内195例成功接受PCI的STEMI患者。PCI后12 h进行中性粒细胞计数检测,随访6个月记录心脏不良事件。根据其中性粒细胞水平分为3组:中性粒细胞4.78×109/L组(A组),32例;中性粒细胞4.78~8.79×109/L组(B组),118例;中性粒细胞8.79×109/L组(C组),45例。结果:①急诊PCI后B组和C组患者TIMI心肌灌注分级(TMPG)0~1级所占比例高于A组、TMPG达3级所占比例低于A组(均P0.05);②C组心功能Killp分级≥2级患者所占比例明显高于A组和B组(均P0.05);③随访6个月时C组心脏不良事件的发生率明显高于A组和B组(均P0.05)。结论:STEMI患者PCI后中性粒细胞水平越高,心肌灌注越差。PCI后中性粒细胞数早期监测有利于急性心肌梗死患者PCI后临床预后的评价。     

中性粒细胞/淋巴细胞比值与AMI患者PPCI术前后梗死相关冠状动脉血流状态的相关性

目的 探讨中性粒细胞/淋巴细胞比值(NLR)与急性心肌梗死(AMI)患者行直接经皮冠状动脉介入治疗(PPCI)前后梗死相关冠状动脉(IRA)血流状态的关系。方法 连续入选598例接受PPCI的AMI(包括STEMI和NSTEMI)患者,依据PPCI前后IRA血流状况分为三组:A组为PPCI前IRA血流TIMI Ⅲ级;B组为PPCI前IRA血流TIMI 0～Ⅱ级,PPCI后IRA血流TIMI Ⅲ级;C组为PPCI前IRA血流TIMI 0～Ⅱ级,PPCI后IRA血流TIMI 0～Ⅱ级,同时检测各组NLR以及相关临床参数,进行统计分析并对相关数据行Logistic回归分析。结果 三组间高敏C反应蛋白(hs-CRP)、NLR、心肌肌钙蛋白T(cTnT)及左心室射血分数(LVEF)等指标存在显著性差异。A组患者hs-CRP、NLR和cTnT值最低,而LVEF值最高;C组患者hs-CRP、NLR和cTnT值最高,而LVEF值最低,且心功能Killip分级≥2级者更常见;C组患者死亡率最高,与IRA血流恢复不佳、NLR升高独立相关。多因素Logistic回归分析显示NLR与IRA血流状态独立相关,高NLR预示PPCI前后IRA血流TIMI 0～Ⅱ级的发生率更高。结论 NLR是IRA血流状态的一个强有力的独立预测因子,高NLR预示AMI患者预后更差,其对行PPCI的AMI患者的早期危险分层具有一定的价值。     

急诊经皮冠状动脉介入治疗术后中性粒细胞升高与预后的相关性

目的 探讨经皮冠状动脉介入治疗(PCI)后中性粒细胞水平与急性ST段抬高心肌梗死(STEMI)患者近、远期预后的关系.方法 连续人选发病12 h内接受成功PCI的初发急性STEMI患者226例.PCI术前及术后2 h分别记录18导联心电图,PCI后12 h内进行中性粒细胞计数检测.采用logistic回归评价PCI后中性粒细胞水平与患者心电图ST段回落以及30 d和2年内发生心脏不良事件的关系.采用Kaplan-Meier生存曲线分析不同中性粒细胞水平的患者30 d和2年生存率的不同.结果 所有患者PCI后的中性粒细胞计数在(2.83～18.74)×109/L,25百分位数、中位数及75百分位数分别为5.66×109/L、7.38×109/L和9.34×109/L.校正其他影响因素后,PCI后中性粒细胞计数每升高1×109/L,急性STEMI患者PCI后心电图ST段未回落的风险增加2.28倍(OR:2.28,P=0.009),30 d内发生心力衰竭(OR:1.16,P=0.035)和死亡(OR:1.63,P=0.010)的风险分别增加1.16和1.63倍,2年内发生心力衰竭(OR:1.20,P=0.007)和死亡(OR:1.29,P=0.003)的风险分别增加1.20和1.29倍,而发生非致死性再次心肌梗死的风险无明显改变.PCI后中性粒细胞计数≥9.34×109/L的患者30 d累积生存率(89.1%比99.1%比98.2%,P=0.010)和2年累积生存率(82.4%比96.1%比96.3%,P=0.003)明显低于(5.66～9.33)×109/L以及＜5.66×109/L的患者.结论 PCI后中性粒细胞升高是初发急性STEMI患者成功PCI后近期和远期发生死亡和心力衰竭的独立预测因子.     

Fractalkine与急性心肌梗死患者PCI术后无复流的关系

目的:研究趋化因子fractalkine与急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后无复流的关系。方法:纳入2017年10月-2019年10月潍坊市人民医院行PCI的195例AMI患者,根据心肌梗死溶栓治疗(TIMI)分级标准分为无复流组(47例)和正常血流组(148例)。比较两组患者基线资料以及相关临床指标,采用ROC曲线评价fractalkine对无复流的预测价值,Logistic逐步回归分析无复流的危险因素。结果:无复流组患者陈旧心肌梗死比例、肌钙蛋白I(cTnI)峰值、C反应蛋白(CRP)、中性粒细胞计数、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)以及fractalkine水平均显著高于正常血流组,淋巴细胞计数显著低于正常血流组(均P<0.05)。Fractalkine预测无复流的ROC曲线下面积为0.897,临界值为945.77 pg/ml,对应敏感度为78.7%,特异度为91.9%。Logistic逐步回归显示,陈旧心肌梗死、CRP、NLR以及血清fractalkine水平是无复流的独立危险因素。结论:Fractalkine是...     

急性STEMI患者术前梗死相关动脉血流异常预测因素

目的探讨经皮冠状动脉介入(PCI)治疗的急性ST段抬高型心肌梗死(STEMI)患者术前梗死相关动脉血流异常的预测因素。方法连续选取2014年12月～2016年6月于西安市第五医院行PCI治疗的急性STEMI患者116例,根据冠脉造影及TIMI分级示血流有无异常分为试验组(血流异常)和对照组(血流无异常),试验组99例,对照组17例,观察记录患者的年龄、身高、体重、病程等基本信息,行彩超、心电图检查及生化检测,计算患者入院时中性粒细胞与淋巴细胞计数比值(NLR)。结果试验组患者淋巴细胞计数低于对照组,中性粒细胞计数、白细胞计数、中性粒细胞与淋巴细胞比值、空腹血糖、吸烟率高于对照组,差异具有统计学意义(P0.05);对变量NLR、LVEL、白细胞计数、淋巴细胞计数、中性粒细胞计数、吸烟、空腹血糖进行多元Logistic回归分析,NLR和空腹血糖是PCI术前梗死相关动脉血流异常的独立危险因素,差异具有统计学意义(P0.05)。结论 STEMI患者空腹血糖及中性粒细胞/淋巴细胞比值(NLR)可作为行患者术前梗死相关动脉血流是否正常的预测指标。     

急性心肌梗死患者血清HMGB2水平与梗死相关血管自发再通的相关性

目的探讨急性心肌梗死(AMI)患者血清高迁移率族蛋白2(HMGB2)水平与梗死相关血管自发再通的相关性。方法共纳入293例拟行急诊经皮冠状动脉介入治疗(PCI)的AMI患者,PCI前检测血清HMGB2水平及相关生化指标,根据心肌梗死溶栓治疗临床试验(TIMI)血流分为两组:非自发性再通组(TIMI血流0～1级,225例)和自发性再通组(TIMI血流2～3级,68例)。应用多因素Logistic回归分析梗死相关血管自发性再通的独立预测因子。结果非自发性再通组血清HMGB2水平明显高于自发性再通组[(7.53±2.28)ng/mL:(3.24±1.26)ng/mL,P <0.01]。多因素Logistic回归分析显示,血清HMGB2水平是梗死相关血管自发性再通的独立预测因子(OR=2.18,95%CI:1.11～4.33,P <0.05)。受试者工作特征曲线显示,以2.15 ng/mL为临界值预测梗死相关血管自发性再通的预测价值敏感度为79.00%,特异度为85.00%。结论血清HMGB2低水平是AMI患者自发性再通的独立预测因子,测定血清HMGB2水平对AMI患者梗死相关血管自发性再通有较高的预测价值。     

血糖对急性ST段抬高心肌梗死再灌注治疗前冠状动脉血流的预测价值

目的评价急性ST段抬高心肌梗死(STEMI)患者血糖水平增高与急诊介入治疗(PCI)前患者冠状动脉TIMI血流的相关性。方法选择120例STEMI行急诊PCI治疗的患者,收集患者入院前全血血糖、PCI前冠状动脉造影梗死相关血管TIMI血流以及患者临床资料。血糖≥7·8mmol/L(140mg/dL)定义为高血糖症。结果在接受急诊PCI术前仅有18例(15%)患者冠状动脉造影血流达到TIMI3级,高血糖症患者87例(72·5%)。正常血糖组在PCI术前TIMI3级的患者多于高血糖症组(两组分别为27·3%和10·3%,P<0·01),但两组随诊期间主要心脏事件的发生率差异无统计学意义。结论高血糖症是STEMI患者PCI前冠状动脉TIMI血流重要的预测因素之一。     

急性ST段抬高型心肌梗死患者发生自发再灌注的预测因素及预后分析

目的观察急性ST段抬高型心肌梗死(STEMI)罪犯血管发生自发再灌注(SR)患者临床特征及造影特点;探讨梗死相关动脉(IRA)发生SR的预测因素;评价两组患者预后情况。方法回顾性分析确诊为急性STEMI并急诊行经皮冠状动脉介入治疗(PCI)的206例患者,根据冠状动脉造影(CAG)结果,按照溶栓治疗临床试验血流分级,TIMI 2~3级定义为SR组56例,TIMI 0~1级定义为未自发再灌注(NSR)组150例;分析两组患者临床特征、造影特点及预后情况,探索自发再灌注预测因素。结果 SR组发生梗死前心绞痛、心电图(ECG)的ST段回落50%、IRA位于冠状动脉前降支(LAD)的比率均高于NSR组(P0.05),而发生应激性高血糖和存在肌桥比率低于NSR组(P0.05);SR组术前胸痛缓解评分、发病到用药时间、肌酸磷酸酶(CK)、肌酸磷酸酶同工酶(CK-MB)、肌钙蛋白I(c Tnl)、肌酐(Scr)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)水平均低于NSR组(P0.05);多因素Logistic回归分析表明,梗死前心绞痛、发病到用药时间、ECG回落50%、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)是发生自发再灌注的预测因素;SR组住院期间心血管不良事件(MACE)发生率低于NSR组(P0.05),三个月后随访心脏功能优于NSR组(P0.05)。结论急性STEMI行PCI治疗之前有一定的自发再灌注率;梗死前心绞痛、发病到用药时间、ECG回落50%、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)可作为自发再灌注的预测因素;SR可减少住院期间主要心血管不良事件(MACE)发生,有益于患者预后。     

Predictive factors of TIMI-3 flow before percutaneous coronary intervention in facilitated percutaneous coronary intervention for acute myocardial infarction

The outcome for facilitated percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is known to be more favorable in cases in which TIMI-3 flow is obtained before PCI. We investigated factors that affect the acquisition of TIMI-3 flow before PCI. Facilitated PCI was performed on 178 patients divided into two groups, a group in which TIMI-3 flow was acquired before conducting PCI and another in which it was not, and their background factors and short-term outcomes were investigated. The hemoglobin concentrations, white blood cell (WBC) counts, and HbA1c values were significantly lower in the group in which TIMI-3 flow was acquired before PCI and significantly more had a history of past smoking. According to the results of logistic analysis, WBC count (odds ratio [OR], 0.865, P = 0.0077), hemoglobin concentration (OR, 0.77, P = 0.0257), and smoking history (OR, 0.266, P = 0.0021) were independent factors that predicted acquisition of TIMI-3 flow. The WBC count and hemoglobin value on arrival at the emergency room and history of smoking were shown to be independent factors for acquisition of TIMI-3 flow before PCI in facilitated PCI.     

Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction

OBJECTIVES: We sought to evaluate and validate the ability of the angiographic myocardial blush grade to risk stratify patients after successful angioplasty in acute myocardial infarction (AMI). BACKGROUND: Although epicardial Thrombolysis In Myocardial Infarction (TIMI)-3 flow is restored in >90% of patients undergoing primary percutaneous coronary intervention (PCI), normal myocardial perfusion may be present less frequently and may detrimentally impact survival. METHODS: A cohort of 173 consecutive patients undergoing intervention within 24 h of AMI onset were studied. High-risk features of this population included failed thrombolysis in 39%, cardiogenic shock in 17% and saphenous vein graft culprit in 11% of patients. RESULTS: Despite the restoration of TIMI-3 flow in 163 (94.2%) patients, myocardial perfusion, as evidenced by normal contrast opacification of the myocardial bed subtended by the infarct artery (myocardial blush), was normal in only 29.4% of patients with TIMI-3 flow following PCI, and in no patient with TIMI 0 to 2 flow. In patients in whom TIMI-3 flow was restored, survival was strongly dependent on the myocardial perfusion grade; one-year cumulative mortality was 6.8% with normal myocardial blush, 13.2% with reduced myocardial blush and 18.3% in patients with absent myocardial blush (p = 0.004). CONCLUSIONS: Abnormal myocardial perfusion is present in most patients following primary or rescue PCI in AMI, despite restoration of brisk epicardial coronary flow. In high risk patients achieving TIMI-3 flow after intervention, the myocardial blush score may be used to stratify prognosis into excellent, intermediate and poor survival. Further study is warranted to examine whether adjunctive mechanical or pharmacologic strategies can further improve myocardial perfusion and survival of patients with acute myocardial infarction undergoing intervention.     

替罗非班对急性心肌梗死患者急诊PCI治疗疗效的影响

目的探讨急性心肌梗死(AMI)患者急诊冠状动脉介入治疗(PCI)不同时间应用替罗非班PCI疗效的差别。方法选择急诊入院的60例AMI患者随机分为早期治疗组(n=30)与晚期治疗组(n=30),早期治疗组于急诊入院即刻静脉给予替罗非班;晚期治疗组于冠状动脉造影后静脉给替罗非班。比较两组患者PCI术前后的TIMI血流分级、TIMI心肌灌注分级(TIMI myocardial perfusion grade,TMPG)、血小板聚集率及出血情况。记录住院期间及随访3个月时的主要心血管事件(心源性死亡、非致死性心肌梗死及再发性心绞痛、主要心脏不良事件)的发生率。结果(1)术前TIMI前向血流达到3级的比例:早期治疗组明显高于晚期治疗组;术后两组差异无统计学意义。(2)术前和术后的TMPG 2-3级比例:早期治疗组均显著高于晚期治疗组。(3)术后血小板聚集率:两组患者均较术前明显下降,两组之间差异无统计学意义。结论AMI患者入院时尽早应用替罗非班对急诊PCI治疗是安全有效的,且能够更明显改善靶血管前向血流TIMI分级及心肌灌注TMPG分级。     

Impact of PercuSurge device conjugative with intracoronary administration of nitroprusside on no-reflow phenomenon following primary percutaneous coronary intervention.

BACKGROUND: The present study tested the hypothesis that when administered in conjunction with a PercuSurge device for treatment of acute myocardial infarction (AMI), intracoronary (IC) administration of nitroprusside (NTP) is safe and superior to IC administration of NTP alone or nitroglycerin (NTG) for reversing slow-flow or no-reflow, both of which occur frequently during primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Sixty-two patients with ST-segment elevation AMI of <12 h duration undergoing primary PCI were enrolled. When the final Thrombolysis In Myocardial Infarction (TIMI) flow was normal (TIMI-3), NTG 200 microg was administered first, followed by (5 min later) NTP 100 microg via an intra-guiding catheter. When final TIMI flow was 相似文献   

Detection of microvascular injury by evaluating epicardial blood flow in early reperfusion following primary angioplasty

BACKGROUND: In a significant proportion of patients with acute myocardial infarction (AMI), successful opening of the infarct related artery (IRA) does not translate into adequate perfusion at the tissue level. We hypothesised that deterioration of epicardial blood flow in early reperfusion may identify early signs of coronary microvascular injury. METHODS: In 272 consecutive patients (age 56.9+/-10.4 years) with AMI treated by primary angioplasty (PCI), coronary blood flow (Trombolysis in Myocardial Infarction (TIMI) scale and corrected TIMI frame count (cTFC)) was evaluated before [B], immediately after [O] and 15 min after [O15] opening of the IRA. The sum of ST-segment elevation in standard ECG leads (sigmaST) was measured at [B], at [O15] and 24 h after [C24]. Microvascular injury was assessed by indexes STi(O15)=sigmaST(O15)/sigmaST(B), STi(C24)=sigmaST(C24)/sigmaST(B), and by peak CK-MB release. Coronary flow deterioration (cTFC(DET)) was defined as the difference between cTFC(O15) and cTFC(O). RESULTS: TIMI-3 flow was achieved in 236 (90.8%) patients at [O]. In the early phase of reperfusion (between [O] and [O15]), TIMI flow deteriorated by >/=1 point in 19 (7.3%) patients despite angiographic optimisation of the PCI result. At [O15] 224 (86.2%) patients had TIMI-3 flow (reflow), 36 (13.8%) patients had TIMI相似文献   

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。     

Facilitated primary coronary intervention with abciximab and very low dose of alteplase during off-hours compared with direct primary intervention during regular hours.

In patients with acute myocardial infarction (AMI), the off-hour presentation is one of the major determinants of door-to-balloon delay. Moreover, the nighttime presentation is associated with increased mortality after primary coronary intervention (PCI). The prompt starting of a therapy able to start recanalization of the infarct-related artery before intervention might improve the results of off-hour primary PCI. We compared the outcome of 212 consecutive patients with AMI undergoing either direct or facilitated PCI according to the hour of presentation. Patients arriving off-hours were pretreated with alteplase (20 mg) and abciximab and underwent facilitated PCI. Patients presenting on-hours underwent direct PCI. A basal Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 was observed in 1.0% of patients undergoing direct PCI and in 44% of patients undergoing facilitated PCI (P = 0.001). More patients starting PCI with a TIMI 3 flow achieved a postinterventional fast TIMI frame count (72.0% vs. 38.8% direct PCI group vs. 34.9% facilitated PCI group with basal TIMI 0-2; P = 0.001) and a TIMI perfusion grade 3 (66.0% vs. 38.8% direct PCI group vs. 39.7% facilitated PCI group with basal TIMI 0-2; P = 0.004). Preinterventional TIMI flow grade 3 was associated with a higher gain in left ventricular ejection fraction at 1 month (10.9% +/- 6.4% vs. 7.0% +/- 9.6% direct PCI group vs. 6.1% +/- 6.0% facilitated PCI group with basal TIMI 0-2; P = 0.005). No significant difference was observed in major bleedings, although there was a trend toward a higher risk in the facilitated PCI group. Patients in the facilitated PCI group achieving a basal TIMI 3 flow showed improved myocardial reperfusion and better left ventricular function recovery. Bleeding complications associated with combination therapy remained an important concern.     

提前应用替罗非班对急性ST段抬高心肌梗死患者急诊介入治疗疗效的影响

目的通过随机对比分析,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)时,提前应用血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班是否安全,以及能否进一步改善急诊PCI疗效。方法2005年4月至2006年4月,160例拟诊急性STEMI的患者接受急诊PCI时联合应用替罗非班,最终158例患者纳入研究,其中男性117例,女性41例,平均年龄58.8±25.2岁(36～78岁)。将患者随机分为两组,第一组共80例,在急诊冠状动脉造影结束后开始应用为常规使用组,第二组78例,在获取知情同意后在急诊室即开始应用者为早期使用组。比较两组间的基础临床状况、术前梗死相关血管前向血流情况,术后血流情况以及出血事件与近期心血管事件。结果两组基础临床情况差异无统计学意义,早期使用组提前39.8min应用替罗非班。早期组术前IRA前向血流达到TIMI2～3级的比率高于常规组(分别为39.7%和23.8%,P=0.040),其中达到TIMI3级的比率亦显著高于常规组(分别为23.1%和10.0%,P=0.032)。两组术后TIMI3级获得率,校正的TIMI计帧数和Blush3级获得率差异无统计学意义。两组近期主要心血管事件发生率、出血事件与血小板减少症发生率差异无统计学意义。结论急性STEMI患者急诊PCI前提前应用替罗非班是安全的,虽然术后造影结果和临床预后并没有明显改善,但是提前应用替罗非班可以提高PCI前的梗死相关血管前向血流。需要设计更大的样本量,更早的应用时机和合适的较大剂量提前应用替罗非班进一步深入研究。     

Two different coronary blood flow velocity patterns in thrombolysis in myocardial infarction flow grade 2 in acute myocardial infarction: insight into mechanisms of microvascular dysfunction

OBJECTIVES: We sought to determine which of the two main potential mechanisms underlying Thrombolysis In Myocardial Infarction flow grade 2 (TIMI-2 flow) operate in an individual patient who has had an acute myocardial infarction (AMI). BACKGROUND: Systolic flow reversal (SFR) is a specific finding of capillary damage, the no-reflow phenomenon. The coronary blood flow velocity (CBFV) pattern of thromboemboli, however, remains unknown. METHODS: Data on 105 patients with AMI (57 with anterior and 48 with nonanterior cases) who underwent a coronary intervention were analyzed. The CBFV was recorded by a Doppler guide wire, and tissue perfusion was assessed with myocardial contrast echocardiography (MCE). RESULTS: Study patients were classified into three groups according to TIMI grade and the presence or absence of SFR: 1) TIMI-3 flow (n = 80); 2) TIMI-2 flow with SFR (SFR[+], n = 14); and 3) TIMI-2 flow without SFR (SFR[-], n = 11). Diastolic CBFV was the lowest in SFR(-) (TIMI-3 vs. SFR[+] vs. SFR[-]: 34 vs. 31 vs. 9 cm/s), and the systolic to diastolic CBFV ratio was also the highest in SFR(-) (0.43 vs. -0.18 vs. 0.66). The no-reflow phenomenon documented by MCE was found in all patients in the SFR(+) group, but in only one patient (10%) in the SFR(-) group. Intracoronary thrombus was more frequently found in SFR(-) than in SFR(+) (91% vs. 14%, p < 0.05). CONCLUSIONS: At least two different CBFV patterns are noted in patients with reperfused AMI who have TIMI-2 flow. Capillary damage is mostly responsible for SFR(+), and SFR(-) is seen in thromboemboli possibly due to increased coronary arterial resistance.     

溶栓后联合介入治疗对急性心肌梗死患者心肌组织灌注的影响

目的:探讨溶栓后联合经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者心肌组织灌注的影响。方法:采用回顾性分析首次AMI患者94例,发病时间均在12 h以内。36例接受溶栓联合PCI治疗,58例接受直接PCI治疗,并于PCI后测定心肌组织灌注分级,了解二者对AMI患者心肌组织灌注的影响。结果:2组患者自发病至PCI时间比较无明显差异;首次冠状动脉造影显示:溶栓联合PCI组PCI前梗死相关动脉TIMI 3 级血流者明显较直接PCI组增多;溶栓联合PCI组介入治疗成功率高,且术后TIMI 3级血流者、PCI后心肌组织灌注TMP 2级以上者均明显多于直接PCI组;2组比较出血并发症发生率无明显差异。结论:溶栓联合PCI治疗AMI安全有效,早期再通率高,心肌微循环灌注好,心肌梗死面积小,更有利于保护心室功能,且不增加出血并发症。