急性心肌梗死急诊介入治疗后心肌灌注评价方法的研究

目的　应用TMP ,CTFC ,maxSTE及sumSTR方法评价急性心肌梗死急诊介入治疗后心肌组织灌注并探讨其与临床预后的关系。方法　6 5例AMI急诊介入治疗后即刻采用TMP、CTFC及心电图(maxSTE ,sumSTR)方法评价心肌组织灌注,记录6个月心脏事件。结果　与双核素心肌灌注显像对比,检验每种评价方法的敏感性、特异性、准确性;maxSTE敏感性80 % ,特异性85. 7% ,准确性83 .1 % ;TMP敏感性73 3% ,特异性80 % ,准确性76 . 9% ;而CTFC( 4 0 ) ,CTFC( 30 ) ,sumSTR30 %和sum STR( 50 )预测价值较低。多变量回归分析显示TMP 0. 1级、maxSTE高危为6个月心脏事件的独立危险因子。结论　TMP ,maxSTE方法可以较好地评价心肌灌注程度,并对6个月临床预后有较好的预测价值。

Methodology of assessment of myocardial reperfusion in patients with acute myocardial infarction after PCI therapy

Objective To assess the values of TIMI myocardial perfusion grade (TMP), corrected TIMI frame count (CTFC), sum-ST-segment resolution (sumSTR), max-ST-segment deviation (maxSTE) in judging myocardial perfusion and to predict their clinical outcomes. Methods In 77 patients with AMI, methods of TMP, maxSTE, sumSTR, CTFC were used to judge myocardial perfusion grade respectively immediately after PCI. Sixty-five patients underwent 99m Tc-MIBI/ 18 FDG DISA SPECT within one months after PCI, in-hospital heart faiures and cardiac events in the 6 months were recorded. Results Compared with 99m Tc-MIBI/ 18 FDG DISA SPECT, sensitivity, specificity, accuracy of TMP, CTFC, maxSTE, sumSTR was calculated. Sensitivity, specificity, accuracy of maxSTE were 80%, 85.7%, 83.1% respectively; Those of TMP were 73.3%, 80%, 76.9%, respectively. But those of CTFC (40), CTFC (30), sumSTR (30%), sumSTR (50%) were lower. By multivariate analysis of TMP0/1, maxSTE was the independent risk factor for 6-month cardiac events. Conclusion TMP, maxSTE may better assess myocardial perfusion, and accurately predict the outcome in 6-months.