急诊经皮腔内冠状动脉成型术(PTCA)无复流现象对预后的影响

目的探讨急诊PTCA中无复流现象的临床意义。方法回顾性分析2001年1月至2002年1月就诊于同仁医院的53例(男37例,女16例,年龄35～78岁)初发急性心肌梗死(AMI)行急诊PTCA的患者。病例被分为无复流组(18例,TIMI≤2级)和PTCA后冠脉血流正常组(35例,TIMI3级),随访6个月,观察有无心脏性猝死和非致命性心脏事件。组间差别采用t检验或χ2检验。结果无复流组发生充血性心衰、恶性≤2级性心律失常、再发心绞痛、心脏性猝死高于冠脉血流正常组(P<0.05)。无复流组6个月后左室射血分数显著低于冠脉血流正常组(P<0.05)。结论无复流现象强烈提示AMI预后不良。但需进一步的大规模临床试验验证。

Clinical significance of no- reflow phenomenon observed in emergency myocardial infarction with percutaneous transluminal coronary angioplasty

Objective To study the clinical significance o f no -reflow phenomenon observed in a cute myocardial in-farction(AMI )with percutaneous transluminal coronary angioplasty(PTCA).Methods The clinical significance of the angio-graphic no -reflowphenomenon was evaluated in 53patients with AMI treated by PTCA.On the basis of the post -PTCAangiograms,patients were divided into two groups:normal angiogram(group 1,n =35),no -reflow(group 2,n =18).Results Regional wall motion in the chronic phase was depre ssed in group 2compared with group 1.The proportion of the area lf the tran smural infarction to that of the total infarction determi ned by scintigraphy was higher in gro up 2than that in group 1.A significan tly higher incidence of myocardial rupture and of death resu lting from cardiac causes was observ ed in group 2compared with group 1.Conclusions The severity of this phenomenon immedia telyafter an emergency PTCA correla ted well with the severity of myocard ial damage,with patients having severe no -reflow sh owing the poorest prognosis.[