无复流现象对急性心肌梗死患者经皮冠状动脉腔内介人治疗时机选择的影响

目的比较研究急性心肌梗死患者行经皮冠状动脉腔内介入治疗(PCI)的时机选择与慢血流/无复流(SNR)现象的关系。方法选择272例急性心肌梗死行PCI治疗的患者为研究对象。TIMI2级血流患者136例,其中60例24h内施行即刻PCI,28例在梗死后24h至一周施行PCI,48例一周后至一月内行PCI;TIMI3级血流患者136例,其中62例在急性心肌梗死发病24h内行PCI,31例发病24h至一周内行PCI,43例一周后至一月内行PCI。分别比较各组的一般情况,冠脉造影梗死相关血管(IRA)行PCI前后的血流情况。结果TIMI2级血流组和TIMI3级血流组中24h至一周内行PCI治疗的患者SNR发生率显著高于24h内即刻PCI组和一周后择期PCI组(8/60vs22/28,22/28vs16/48,P均<0.05)(14/31vs6/62,14/31vs4/43,P均<0.05),且在TIMI2级血流组中即刻PCI组的SNR发生率明显低于一周后择期PCI组(8/60vs16/48,P<0.05);TIMI3级血流组中即刻PCI组的SNR发生率与一周后择期PCI组无差异(6/62vs4/43,P<0.05);TIMI2级与TIMI3级血流组在24h至一周内行PCI的患者SNR的发生率差异显著(22/28vs14/31,P<0.05)。结论急性心肌梗死患者即刻PTCA的血流恢复优于择期PTCA,尤其TIMI血流≤2级的患者。

Time Choice of PCI in Patients with Acute Myocardial Infarction

Objective To compare the effect of time choice on Slow-flow No-reflow(SNR) phenomena in patients with acute myocardial infarction(AMI) who underwent percutaneous coronary intervension(PCI).Methods 272 patients receiving PCI were enrolled.According to TIMI flow,the patients were divided into 2 study populations,who were divided into 3 groups according to immediate PCI or elective PCI,respectively.Results Patients receiving PCI from 24h to one week had more incidence of SNR according to 2 study populations(22/28 vs 8/60,22/28 vs 16/48 P<0.05)(14/31 vs 6/62,14/31 vs 4/43,P<0.05).Furthermore,patients of immediate PCI had less SNR incidence than those receiving PCI from one week to one month according to TIMI grade 2(8/60 vs 16/48,P<0.05).Achievement of TIMI flow grade 3 according to TIMI grade 3 had no significant difference in patients receiving PCI from 24h to one week and those immediate PCI(6/62 vs 4/43,P<0.05).Patients receiving PCI from 24h to one week had higher mortality of SNR in TIMI grade 2 group,compared with TIMI grade 3 group(22/28 vs 14/31,P<0.05).Conclusion Patients with AMI who underwent immediate PCI had less SNR incidence than those of patients who received elective PCI.