Attenuation of myocardial reperfusion injury by sulfhydryl-containing angiotensin converting enzyme inhibitors

Summary Recent studies have suggested the beneficial effects of angiotensin converting enzyme (ACE) inhibitors against myocardial ischemic-reperfusion injury. This study was designed to compare the cardioprotective effects of two sulfhydryl ACE inhibitors, captopril and zofenopril, with those of a nonsulfhydryl ACE inhibitor, fosinopril. The efficacy of these ACE inhibitors to scavenge oxygen radicals in vitro were also examined. Isolated rat hearts perfused by the Langendorff technique were preperfused in the presence or absence of ACE inhibitors (50 m for 15 minutes), and the hearts were then subjected to 30 minutes of ischemia followed by 30 minutes of reperfusion. Zofenopril and captopril, but not fosinopril, improved postischemic left ventricular functions and reduced myocardial cellular injury, as evidenced by improved recovery of the first derivative of left ventricular pressure development and reduced creatine kinase release compared with control (p<.05). Coronary flow was significantly increased by captopril and zofenopril only. The same two drugs also inhibited the enhanced lipid peroxidation during reperfusion. Although significant differences were not noticed in the postischemic myocardial membrane phospholipid composition, captopril and zofenopril reduced nonesterified fatty acid contents, including palmitic, linoleic, oleic, and arachidonic acids. In vitro studies demonstrated that captopril and zofenopril were able to scavenge hydroxyl radicals. These results indicate that among three ACE inhibitors, two sulfhydryl-containing drugs, captopril and zofenopril, possess cardioprotective as well as free-radical scavenging abilites. Attenuation of phospholipid degradation and lipid peroxidation may be contributory to the protective effects observed in this study.     

Effect of spontaneous reperfusion on myocardial infarct size

The effect of perfusion of the infarct artery on myocardial infarct size was studied in 39 patients who had not received interventive therapy. At predischarge coronary angiography, 19 patients had subtotal and 20 total occlusion of the infarct artery. The early ST-segment elevation recorded on a 12-lead electrocardiogram was used as an index of the amount of initially jeopardized myocardium. Infarct size was estimated by peak serum creatine kinase and, at discharge, by a QRS score, sigma Q and sigma R on a 12-lead electrocardiogram, and by radionuclide global and infarct segment left ventricular ejection fraction. Despite a similar degree of initial ischemia (sigma ST), infarct size was smaller in the 11 patients with anterior infarction and subtotal occlusion than in the 9 patients with anterior infarction and total occlusion when measured by peak serum creatine kinase (2114 +/- 1192 U/l vs. 3653 +/- 1059 U/l, p less than 0.02), QRS score (5.0 +/- 2.7 vs. 9.6 +/- 3.5, p less than 0.01), sigma Q (3.25 +/- 2.74 mV vs. 5.92 +/- 3.56 mV, p less than 0.10), sigma R (4.36 +/- 1.25 mV vs. 2.16 +/- 0.91 mV, p less than 0.001), global left ventricular ejection fraction (45.0 +/- 12.2% vs. 33.4 +/- 6.7%, p less than 0.05), and infarct segment ejection fraction (40.4 +/- 8.2% vs. 30.3 +/- 5.4%, p less than 0.05). In the inferior infarct patients, both the degree of initial ischemia and final infarct size were similar in the 8 patients with subtotal and in the 11 patients with total occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Early angiotensin converting enzyme inhibitor therapy enhances the benefits of late coronary artery reperfusion on infarct expansion

BACKGROUND: Individually, both late reperfusion and early angiotensin converting enzyme (ACE) inhibitor treatment prevent infarct expansion after acute myocardial infarction. OBJECTIVE: To examine the effect and mechanism of early post-myocardial infarction ACE inhibitor treatment, when used in combination with late coronary artery reperfusion, on infarct expansion. METHODS: Sprague-Dawley rats underwent 8 h of coronary occlusion followed by permanent reperfusion. The treatment group received enalapril, started 1 h after coronary occlusion and continued for 13 days. A control group received placebo. Two weeks after acute myocardial infarction, hemodynamic, morphometric and histologic analyses were performed. RESULTS: Hemodynamic parameters were similar in both groups (P = NS). Infarct size was similar in the ACE inhibitor and placebo treatment groups (44 +/- 4% compared with 39 +/- 4%, P = NS). Septal thickness was also similar in the two groups (2.8 +/- 0.3 mm compared with 2.7 +/- 0.3 mm, P = NS). The ACE inhibitor-treated group had thicker infarcts than those in the placebo-treated group (0.93 +/- 0.07 mm compared with 0.76 +/- 0.04 mm, P < 0.05) and these infarcts were less expanded (expansion index 1.17 +/- 0.12 compared with 1.57 +/- 0.12, P < 0.05). ACE inhibitor treatment was associated with hypertrophy of viable myocytes within the scar compared with placebo treatment (cell diameter 11.1 +/- 0.5 microns compared with 8.9 +/- 0.4 microns, P < 0.01). CONCLUSIONS: Early post-myocardial infarction ACE inhibitor treatment enhances the benefits of late coronary reperfusion on infarct expansion. The benefits may be related to hypertrophy of still-viable myocytes within the infarcted zone.     

Identification of patients prone to infarct expansion by the degree of regional shape distortion on an early two-dimensional echocardiogram after myocardial infarction

Early detection of potential expanders (patients who develop clinically significant infarct expansion with acute left ventricular (LV) dilatation and failure but no necrosis) after acute myocardial infarction (AMI) is necessary in order to apply preventive therapy. To determine whether the degree of regional shape distortion (RSD), or dilatation, on early two-dimensional echocardiogram (2-D echo) after AMI can identify potential expanders, serial clinical and echocardiographic data were studied prospectively in 244 consecutive patients with a first Q-wave AMI. Initial (mean 2 days) and final (mean 10 days) two-dimensional echocardiograms were compared for regional LV asynergy, RSD, and conventional indices of expansion measured on endocardial diastolic outlines of mid-LV short-axis sections. Analysis of clinical and 2-D echo data revealed 51 expanders and 193 nonexpanders. Expanders showed greater LV dysfunction and more inhospital deaths (27% vs. 8%, p less than 0.001) compared with nonexpanders; conventional indices of expansion showed more marked increase between initial and final two-dimensional echo in expanders, but initial indices were not predictive. In contrast, the new RSD index Pk, a measure of the outward bulge, was markedly greater in expanders than nonexpanders on both initial (16.5 vs. 2.4 mm, p less than 0.001) and final echo. Furthermore, expanders with greater than or equal to 30% increase in Pk (to 21 mm) developed rupture of the ventricular septum (n = 10) or free wall (n = 2). Also, 50 of 51 expanders compared with 3 of 193 nonexpanders had a Pk greater than or equal to 10 mm on the initial echo. A simpler index, the depth of RSD (rd), provided similar discrimination as Pk. Thus, the degree of diastolic RSD on an early 2-D echo after AMI can identify potential expanders.     

早期再灌注对急性心肌梗死患者血浆脑钠素水平的影响

目的 :探讨早期再灌注对急性心肌梗死 (AMI)患者血浆脑钠素 (BNP)水平的影响。方法 :选择AMI患者 5 6例 ,胸痛发作 12h内成功再灌注者 (38例 )为试验组 ,再灌注失败或未进行再灌注者 (18例 )为对照组。ELISA法测定入院即刻、1、2、7、14、2 8d时血浆BNP水平。结果 :AMI患者血浆BNP水平较正常人明显升高 ;试验组血浆BNP水平呈单峰曲线 ,对照组呈双峰曲线 ;再灌注可明显降低AMI患者BNP水平 ,第 7天时浓度升高不明显 ,未形成第 2个高峰。结论 :早期再灌注可明显降低血浆BNP水平。     

Eligibility for reperfusion therapy and outcome in elderly patients with acute myocardial infarction

Reperfusion therapy by thrombolysis or angioplasty was consideredin 260 unselected patients consecutively admitted within 6 hof the onset of Q wave myocardial infarction. Rates of reperfusionand in-hospital mortality were compared in 206 patients <70years and 54 patients 70 years. Early reperfusion was obtainedin 864% of the patients under 70 years and in 72·2% ofthose over 70 (P<0·01). Thrombolysis was more frequentlyused in the younger group (66·0% vs 31·5%, P<10^–5and primary angioplasty in the older (44·4% vs 29·6%,P<0·05). Overall in-hospital mortality was higherin the older group (22·2% vs 4·4 P<10^–5After successful reperfusion, mortality was 12·8% inthe patients over 70 and 3·9% in those under 70. Afterfailed or unproven reperfusion, mortality was 46·7% inthe patients over 70 and 7·1% in those under 70. Reperfusiontherapy is feasible in the majority of patients over 70 years,but failure to attempt or to achieve reperfusion is associatedwith a poor outcome. Although not controlled, this study providesan incentive for attempting early reperfusion therapy as oftenas possible in the elderly with acute myocardial infarction.     

Rapid myoglobin analysis to assess coronary artery reperfusion after acute myocardial infarction

Background: Coronary artery reperfusion significantly improves outcome in patients with acute myocardial infarction. A noninvasive method for assessing reperfusion in the early stage of infarction should be helpful in patient management. Hypothesis:We sought to assess whether release pattern of myoglobin is helpful in identifying patients with and without reperfusion following thrombolytic therapy for myocardial infarction. Methods: Myoglobin was measured before thrombolysis, half hourly for 4 h, then every 2 h for 10 h. Myoglobin was analyzed using a ward-based “rapid” and automated analyzer that yielded quantitative results within 10 min of blood collection. Results: In the 15 patients with coronary reperfusion, the time from thrombolysis to peak myoglobin levels (mean ± SD, 2.4 ± 1.5 h) was significantly lower than in nonreperfused patients (5.1 ± 2.9, p < 0.01). As an indicator for reperfusion, a doubling of myoglobin 1 h after streptokinase achieved a sensitivity of 80%, a specificity of 80%, and a predictive accuracy of 80%. Conclusions: The difference in myoglobin release kinetics is useful in identifying patients without coronary reperfusion and should aid in their management.     

及时再灌注对急性心肌梗塞近期预后的影响

根据溶栓治疗后梗塞相关冠状动脉获开通的时间不同，将５９例急性心肌梗塞（ＡＭＩ）病人分为＜６小时组和＞６小时组，又根据溶栓后冠状动脉造影显示的冠状动脉通畅的程度不同，分为通畅组、基本通畅组和未通组，观察梗塞相关血管开通的不同时间和不同程度对心肌梗塞近期预后的影响。结果发现，６小时内开通者可明显降低心肌梗塞面积，改善梗塞后左室功能以及减少并发症的发生，＞６小时开通组与未通组相比，也有一定程度缩小梗塞面积和减少并发症的作用；基本通畅组近期心律失常、心绞痛以及再梗塞率高于通畅组和未通组，但基本通畅组和通畅组心肌梗塞缩小面积差异无显著性。提示ＡＭＩ后梗塞相关血管及时有效再灌注有利于改善心肌梗塞的近期预后。     

心电图在诊断急性心肌梗死相关动脉中的价值

目的分析急性心肌梗死患者不同梗死部位心电图表现及梗死相关动脉的分布特点,评价心电图诊断梗死相关动脉的价值。方法对132例急性心肌梗死患者心电图和冠状动脉造影资料进行回顾性比较分析。结果心电图显示心肌梗死发生率以心脏下壁、前间壁和广泛前壁最高,分别为31例(23.5%)、26例(19.7%)和22例(16.7%);造影显示梗死相关动脉的发生率分别为左主干(LM)3例(2.3%)、前降支(LAD)73例(55.3%)、回旋支(LCX)18例(13.6%)、右冠状动脉(RCA)38例(28.8%);前壁心肌梗死(55例)的梗死相关动脉多为LAD(51例,92.7%),下壁心肌梗死(31例)的梗死相关动脉多为RCA(22例,71.0%)或LCX(7例,22.6%),且与冠状动脉优势类型密切相关,前壁梗死合并aVR、aVL导联ST段抬高对诊断LAD近段闭塞的特异性较高,分别为86.7%和90.0%。结论急性心肌梗死心电图表现与梗死相关动脉存在明显相关性,有较高的临床诊断价值。     

Effects of late coronary artery reperfusion on left ventricular remodeling persist for 10 weeks after experimental rat myocardial infarction and are associated with improved survival

Objective: To test the hypothesis that coronary artery reperfusion performed too late to reduce infarct size improves survival by altering left ventricular remodeling and preventing progressive left ventricular dilation.Background: Several clinical trials have suggested that late coronary artery reperfusion without infarct size reduction is associated with a survival benefit. Although the mechanism is not known, survival benefits could be related to decreased infarct expansion associated with late coronary artery reperfusion. Decreased infarct expansion results in decreased left ventricular volume, and the resulting decreased wall stress could prevent or attenuate progressive left ventricular dilation and improve survival.Methods: Rats (n=84) were randomized to undergo sham operation, permanent left coronary artery ligation, or 2 hours of left coronary artery ligation followed by reperfusion. Ten weeks later, hemodynamic measurements were made before and after volume loading. The rats were killed, the hearts were removed, and passive pressurevolume curves were obtained. The hearts were fixed at a constant pressure and analyzed morphometrically.Results: When examined 10 weeks after experimental myocardial infarction, late reperfusion's effects on left ventricular remodeling resulted in reduced left ventricular volume when compared to hearts with infarcts supplied by a permanently occluded coronary artery (1.9 ± 0.1 ml/kg vs. 2.1 ± 0.2 ml/ kg; p < 0.01). Although there was a trend toward less thinning (0.95 ± 0.13 mm vs. 1.00 ± 0.10 mm; p=NS) and less expansion (2.3 ± 0.4 vs. 2.8 ± 0.9; p=NS) in reperfused hearts compared to hearts with a permanently occluded coronary artery, changes in infarct shape 10 weeks after infarction were not significantly different. Reperfusion's beneficial effects on remodeling of noninfarcted myocardium were associated with improved survival. Mortality was higher in the permanently occluded rats than in the reperfused rats (35% vs. 12%; p < 0.05).Conclusion: Late coronary artery reperfusion has a beneficial effect on remodeling of noninfarcted myocardium that results in reduced left ventricular volume in rat hearts examined 10 weeks after infarction. These beneficial effects on left ventricular remodeling are associated with improved survival.     

糖尿病并发急性心肌梗死溶栓后冠状动脉开通者的近期预后

目的 :研究糖尿病并发急性心肌梗死 (AMI)溶栓治疗冠状动脉完全开通后的近期预后。方法 :对 2 1例糖尿病并发 AMI溶栓后 ,急诊冠状动脉造影显示梗死冠状动脉开通者的冠状动脉造影结果进行分析 ,并于梗死后 3～ 4周内行核素心室造影和 2 4h动态心电图检查 ,观察心功能、心肌缺血和心律失常的情况 ,且随访梗死后 3～ 5周内心绞痛等并发症的发生率 ,并与 37例非糖尿病 AMI溶栓后冠状动脉开通者进行比较。结果 :与非糖尿病组相比 ,糖尿病组冠状动脉的残余狭窄较重 ,冠状动脉病变积分较高 ;梗死后近期左室功能较差 ,心肌缺血的发生率较高。结论 :糖尿病并发 AMI溶栓后冠状动脉开通者冠状动脉病变仍然较重 ,近期预后较差     

Chronic oral pretreatment with the angiotensin converting enzyme inhibitor, trandolapril decreases ventricular fibrillation in acute ischaemia and reperfusion

The effect of chronic angiotensin converting enzyme (ACE) inhibitionon the incidence of fatal ventricular fibrillation during regionalmyocardial ischaemia and reperfusion is not known. A reductionin cardiac angiotensin II and/or a vagomimetic response mayresult in antiarrhythmic activity. Pigs pre-treated with theACE inhibitor trandolapril 0.3 mg. kg^–1 or placebo orallyfor 10 days were subjected to thoracotomy. The left anteriordescending coronary artery was ligated (CAL) for 20 min andreperfused for 45 min. Trandolapril decreased cardiac ACE activityand prevented the fall in the ventricular fibrillation threshold(VFT) during ischaemia: after 5 min of ischaemia the VET inthe trandolapril group was 25.5 ± 4.6 mA (mean ±SEM) vs 13.1 ± 2.2 mA in the placebo group (P<0.05).Trandolapril also decreased the incidence of spontaneous ventricularfibrillation during reperfusion to 116 vs 617 in the placebogroup (P<0.05). Heart rate in the trandolapril group fell.During ischaemia, trandolapril increased blood flow in the non-ischaemiczone, but decreased blood flow in the central ischaemic zoneof the left ventricle. Similarly it decreased tissue levelsof phosphocreatine in this zone. During reperfusion trandolaprilincreased blood flow both in non-ischaemic and central ischaemiczones. Chronic oral pre-treatment with trandolapril resultedin marked antifibrillatory effects which were associated withinhibition of cardiac ACE activity and a decreased heart rate.     

The effect of high plasma levels of angiotensin-converting enzyme (ACE) and plasminogen activator inhibitor (PAI-1) on the reperfusion after thrombolytic therapy in patients presented with acute myocardial infarction

The resistance to thrombolytic agents and delays in reperfusion occur in more than 30% after acute myocardial infarction. This may play an important role in the unsuccessful recanalization after thrombolytic therapy. The aim of this study is to assess the clinical and biochemical markers of reperfusion after different types of thrombolytic therapy and to find out the relationship between PAI-1 and ACE serum levels and the short-term outcome. Pretreatment ACE and PAI-1 plasma levels of 184 patients with acute myocardial infarction, treated with thrombolytic therapy were determined. Failure of thrombolysis was considered when reperfusion was delayed as assessed by noninvasive reperfusion criteria, reinfarction, and impaired left ventricular function. High plasma level of ACE (> 50 U/L), PAI-1 (> 43 ng/ml) and both was found in 57, 108 and 32 patients respectively. Subjects with high ACE plasma levels were characterized by impaired LV systolic function (79.0% vs. 75.0%), new Q-wave (88.4% vs. 74.2%), less reperfusion arrhythmia (19.3% vs. 22.8%) and prolonged hospitalization (70% vs. 66%) but no statistical significance was observed. High enzymes levels of PAI-1 were observed with higher incidence of anterior myocardial infarction (50.0% vs. 41.0%), lesser ST segment resolution (65.6% vs. 58.8%), reinfarction (6.3% vs. 5.9%), and impaired LV systolic function (90.6% vs. 76.0%), and prolonged hospitalization (70.4% vs. 63.4). There was a statistically significant difference between thrombolytic agents in the presence of high ACE regarding hospital overstay (p = 0.02). While the presence of high PAI-1 was significantly affect the degree of ST-segment resolution (p = 0.03). Conclusion: High plasma ACE and/or PAI-1 plays a considerable role in the higher incidence of unsuccessful reperfusion and impaired left ventricular function after thrombolytic therapy. A rapid diagnostic tool that enables physician of detecting those enzymes before giving thrombolytic therapy may change the strategy of treatment to offer another effective revascularization method.     

Serum myoglobin for the early non-invasive detection of coronary reperfusion in patients with acute myocardial infarction

The ideal non-invasive method for detectmg coronary reperfusionhas not yet been established. In 63 patients with acute myocardialinfarction, serum myoglobin and creatine kinase-MB were measuredevery 15mm. Thrombolytic treatment was given (n=52) and acutecoronary angiography showed a patent infarct-related arteryin 49 patients while 14 patients had no coronary reperfusion.Median time to peak serum myoglobin was shorter (reperfusiongroup 178 mm vs no reperfusion group 480 min, P<0·0001)than time to peak serum creatine kinase-MB (reperfusion group550 mm vs no reperfusion group 1080 min, P<0·0001),P<0·0001. Myoglobin appearance rate, calculated asthe concentration at 2 h divided by baseline values (Mb₂/Mb₀)was highest in the reperfusion group (4·0 vs 1·6),P<0·001. An earlier proposed index, Mb₂/Mb₀>2·4 for identificationof reperfusion 2 h after thrombolytic therapy, showed predictivevalues of positive and negative tests of 0·94 and 0·44,respectively. Combining this mdex with signs of medium to largerinfarct size (Mb₂>200 µg . 1^–1)increased thepredictive value of the negative test to 1·00. In patientswith signs of minor mfarcts (Mb₂ <200 .µg .1^–1)the predictive values of positive and negative tests were 0·94and 0·79 respectively, 5 h after onset of thrombolytictherapy. An early rise and a peak in serum myoglobin values seems tobe a reliable and simple non-invasive indicator of successfuland unsuccessful reperfusion therapy. (Eur Heart J 1996; 17: 399–406)     

Angiotensin I-converting enzyme gene polymorphism, coronary artery disease and myocardial infarction. An angiographically controlled study.

Objectives: We investigated the association between insertion/deletion polymorphism of the angiotensin I-converting enzyme (ACE) gene, the presence and extent of coronary artery disease, and myocardial infarction. Background: The D allele of the ACE gene has been associated with coronary artery disease and myocardial infarction, but this association has been challenged in epidemiological studies. Methods: Nine hundred and sixty-nine men and 341 women undergoing coronary angiography were studied. The ACE genotypes were assessed by polymerase chain reaction from genomic deoxyribonucleic acid, homozygosity for the D allele was controlled using an insertion-specific primer. Coronary artery disease was defined by angiographic criteria, the extent of coronary artery disease by the number of coronary arteries with >/=50% lumen narrowing. Results: The ACE genotypes did not differ in terms of age, sex, body mass index, blood pressure, plasma lipids or lipoproteins. We found no association between the ACE genotypes and coronary artery disease (odds ratio, 95% confidence interval in DD genotypes for coronary artery disease in men 0.97, 0.70-1.36; in women 1.56, 0.95-2.57), extent of coronary artery disease (men 1.17, 0.85-1.61; women 1.24, 0.65-2.34), or myocardial infarction among the patients with coronary artery disease (men 1.07, 0.78-1.48; women 0.95, 0.50-1.76). The ACE genotype was not associated with coronary artery disease or myocardial infarction in hypertensives (n=771; odds ratio for coronary artery disease 0.93, 0.65-1.34; odds ratio for myocardial infarction 0.94, 0.66-1.33), or in patients 相似文献   

急性心肌梗死患者早期干预过程中血浆P选择素水平的动态变化

目的观察急性心肌梗死(AMI)患者早期干预过程中血浆P选择素、TNF-α以及细胞间黏附分子-1(ICAM-1)水平的动态变化和早期再灌注治疗对其水平的影响。方法AMI患者31例(AMI组),经冠状动脉造影证实的稳定性心绞痛(SAP)患者17例(SAP组),冠状动脉造影正常者19例(对照组)。分别于发病6、12、24、487、2 h抽取静脉血。使用ELISA法测定血浆P选择素、TNF-α及ICAM-1水平。结果AMI组患者发病6 h内P选择素的浓度显著高于SAP组和对照组(P<0.01);12 h P选择素浓度进一步升高;24 h P选择素明显下降,但仍高于SAP组和对照组(P<0.05);48、72 h P选择素浓度与对照组比较无统计学差异。AMI组患者发病6 hTNF-α与ICAM-1即升高,24 h达高峰,72 h后仍高于正常。直线相关分析,AMI患者发病6 h的P选择素与TNF-α、ICAM-1水平呈正相关(r=0.76,P<0.01;r=0.69,P<0.01)。结论早期成功干预治疗使P选择素很快达峰值,然后迅速下降,但对TNF-α和ICAM-1水平变化的影响则不显著。     

冠状动脉介入治疗再灌注时间对急性前壁心肌梗死左室重构及远期预后的影响

目的评价冠状动脉介入治疗(PCI)再灌注时间对急性前壁心肌梗死左室重构及远期预后的影响。方法选择113例首次急性前壁心肌梗死患者,冠状动脉造影证实梗死相关动脉(IRA)完全闭塞(TIMI0～1级)。依据PCI再灌注时间分为3组,A组35例,6h内IRA成功再灌注;B组40例,6～12h内IRA成功再灌注;C组38例,12～24h内IRA成功再灌注。分别于术后即刻和6个月行冠状动脉造影及左心室造影,对比分析3组左心室造影的心功能指标:左心室舒张末容积、左心室收缩末容积、左心室射血分数、每分输出量、心脏指数,并观察1年内主要不良心脏事件(MACE)的发生情况。结果成功再灌注即刻,3组之间各项心功能参数无显著性差异。6个月时A组和B组各项心功能参数较即刻有改善趋势;C组较前下降,但均无统计学意义。1年随访期间,A、B组无死亡及再次心肌梗死事件发生。心绞痛的发生在3组中无差别。C组心力衰竭及死亡的发生均明显高于A、B组。结论前壁心肌梗死后尽早行PCI,开通IRA,可阻抑左室重构,改善心功能,减少死亡等MACE的发生,从而改善预后。     

急诊PCI术中再灌注心律失常的研究

目的探讨急性心肌梗死患者急诊行经皮冠状动脉介入术(PCI)中再灌注心律失常(RA)的临床特点。方法回顾性分析125例急性心肌梗死且急诊行PCI术治疗患者的临床资料。观察分析再灌注心律失常与梗死相关动脉(IRA)开通所需时间、IRA是否完全闭塞及梗死面积大小的之间的关系。结果 125例患者中85例发生RA(68%)。梗死6h内开通冠状动脉者再灌注心律失常发生率明显高于6～12h开通者(p<0.05)。完全闭塞组RA发生率总体发生率均显著高于次全闭塞组RA发生率(p<0.05)。广泛前壁心肌梗死与局限性心肌梗死RA的发生率无统计学差异(p>0.05)。结论 AMI患者直接PCI后RA发病率及严重程度与IRA病变程度、发病至开通IRA时间明确相关,与梗死面积无关。     

急性心肌梗死合并三度房室传导阻滞的预后及再灌注治疗的意义

目的分析急性心肌梗死合并三度房室传导阻滞(Ⅲ°AVB)患者的临床特征,探讨再灌注治疗对急性心肌梗死合并Ⅲ°AVB预后的意义。方法1992年~2005年连续入院的急性心肌梗死合并Ⅲ°AVB患者51例(Ⅲ°AVB组),每组选择前后相继入院的急性心肌梗死患者2例,共102例构成非Ⅲ°AVB组。比较两组基线临床资料、住院期间死亡率、并发症,以及再灌注治疗的差异。观察Ⅲ°AVB组12h内有效再灌注治疗的病例和未能再灌治疗的病例住院期间的转归。结果(1)与非Ⅲ°AVB组比较,Ⅲ°AVB组发病年龄较大,下壁或右心室梗死比例高,住院期间死亡、心室颤动、KillipⅣ级心功能、心源性休克发生率高,需要起搏治疗的例数多,两组差异有统计学意义。(2)Ⅲ°AVB组排除既往有心肌梗死史及合并其他全身疾病的病例5例,其余46例,17例发病12h内再灌注治疗,住院期间死亡1例,29例未再灌注治疗,死亡12例,P<0.02.。结论急性心肌梗死合并Ⅲ°AVB预后差,住院期间死亡率高。12h内再灌注治疗患者住院期间死亡例数相对较少,这种预后的差异是否有普遍意义,还需进一步研究。     

急性心肌梗死患者不同冠状动脉病变对介入术后预后的影响

目的探讨急性心肌梗死经皮冠状动脉介入治疗患者不同冠状动脉病变对预后的影响。方法将117例接受急诊经皮冠状动脉介入治疗的急性心肌梗死患者根据罪犯血管不同分为左前降支组51例、左回旋支组27例、右冠状动脉组39例。比较3组患者术后ST段回落〉70％的梗死相关导联数、TIMI血流分级、住院期间及出院后1年内主要心脏不良事件发生率。结果与左回旋支组和右冠状动脉组比较,左前降支组术后ST段完全回落的梗死相关导联数和左室射血分数显著降低（P〈0．05）,心源性死亡率及总主要心脏不良事件率显著升高（P〈0．05）。结论左前降支病变者术后心电图ST段回落更缓慢、左心功能不全更严重、主要心脏不良事件发生率更高、预后更差。