急诊介入治疗对非梗死相关动脉灌注的影响

目的 探讨急性ST段抬高型前壁心肌梗死(STEMI)患者行直接经皮冠脉介入治疗(PCI)对非梗死相关动脉血流灌注的影响。方法 入选117例罪犯血管为左前降支(LAD),并接受直接PCI治疗的急性ST段抬高型前壁心肌梗死患者(研究组),另入选100例冠脉造影正常的患者为对照组。观察STEMI患者(研究组)直接PCI术前和术后罪犯血管(LAD)和非梗死相关动脉左回旋支(LCX),狭窄程度＜50％]校正TIMI帧计数(CTFC)和MBG心肌灌注分级的差异,以及正常对照组患者LAD和LCX的校正TIMI帧计数(CTFC)和MBG心肌灌注分级;另外通过静脉采血,分析患者C反应蛋白(CRP)水平;并对患者的临床及造影特点进行分析。结果 罪犯血管为LAD的急性前壁心肌梗死患者,非梗死相关动脉(LCX)直接PCI术前的校正TIMI帧计数( CTFC)多于正常对照组(P＜0.05),MBG心肌灌注分级水平低于正常对照组;直接PCI术后非梗死相关动脉的校正TIMI帧计数(CTFC) (P ＜0.05)和MBG心肌灌注分级均较术前改善,但是仍然未达到正常对照组水平;直接PCI术后罪犯血管发生无复流的患者,其非梗死相关动脉发生无复流的比率较高(78％ vs.8％,P＜0.01),并且血清CRP水平高于未发生无复流的患者(P＜0.05)。结论 急性心肌梗死患者非梗死相关动脉血流灌注也可能受到影响,尽管罪犯血管的直接支架术可改善非梗死相关动脉的血流灌注和心肌灌注,但是其水平仍然低于正常对照组,该现象可能和炎症机制相关。

The impact of primary PCI in culprit Artery on epicardial blood flow of nonculprit artery in patients with anterior STEMI

Objective To study the impact of primary PCI in culprit artery on epicardial blood flow of nonculprit artery in patients with STEMI. Methods Enrolled 117 patients with anterior wall STEMI were treated with primary PCI in the culprit artery, left anterior descending artery (LAD, as study group.Another 100 patients with normal coronary artery evidenced by angiography were enrolled as control group.The differences in CTFC (corrected TIMI frame count measured by using digital subtraction arteriography,TIMI =thrombolysis in myocardial infarction) and MBG (myocardium blood flow perfusion grading)between pre and post primary PCI in both culprit artery and nonculprit artery ( left circumflex artery, LCX),and CTFC and MBG were also detected in the subjects of control group. Blood samples were collected and the levels of CRP (C-reactive protein) were assayed. Clinical and angiographic features were analyzed.Results The CTFC of nonculprit artery (LCX) and the level of MBG in patients with anterior wall STEMI were different from the level of MBG and CTFC in control group ( P＜0. 05) before primary PCI. The level of MBG and CTFC in nonculprit artery (LCX) were improved (P ＜ 0. 05 ) after primary PCI, but they did not resume to normal level. Patients without reflow in culprit artery had higher incidence of no reflow in nonculprit artery than patients with re-flow (78％ vs. 8％, P ＜ 0. 01 ), and the level of CRP in patients without reflow in nonculprit artery were higher than those in patients with re-flow ( P ＜ 0. 05). Conclusions The perfusion of nonculprit artery may be impaired in patients with STEMI. Although the perfusion of nonculprit artery may be improved after primary PCI in culprit artery, but it was still lower than those in the control group, and inflammation mechanism might contribute to it.