急性右心室心肌梗死并左心室下壁、前壁梗死经皮冠状动脉介入治疗对脑利钠肽水平及心室重构的影响

摘 要： 目的 进一步探讨急性右心室心肌梗死并左心室下壁、前壁梗死直接和延迟经皮冠状动脉介入治疗(PCI)对血浆脑利钠肽(BNP)水平及心室重构的影响。方法 急性右心室心肌梗死并左心室下壁、前壁梗死患者207例，分为急性右心室梗死并左心室下壁梗死组和急性右心室梗死并左心室前壁梗死组。分别比较二组患者PCI治疗前血浆BNP水平、心肌酶、血流动力学及冠状动脉病变特点；比较直接和延迟PCI治疗前后血浆BNP水平、左室射血分数（LVEF）、左室舒张末期内径（LVEDd）变化的意义。结果 急性右心室心肌梗死并左心室前壁梗死组PCI治疗前血浆BNP水平高、肌酸激酶(CK) 峰值及肌酸激酶同工酶(CK-MB)峰值高、肺动脉收缩压高、梗死相关冠状动脉狭窄程度及2支病变发生率高与急性右心室心肌梗死并左心室下壁梗死组比较差异有统计学意义(P <0.05)。直接和延迟PCI治疗后均能使血浆BNP水平及LVEDd较术前下降(P<0.05)，但直接PCI治疗术后血浆BNP水平更低、LVEDd改善更明显(P<0.05)。未行PCI治疗的死亡发生率明显高于行直接PCI及延迟PCI治疗的患者，差异有统计学意义(P<0.05)。结论 急性右心室心肌梗死并左心室前壁梗死血浆BNP水平高，梗死相关冠状动脉病变严重；直接PCI治疗后心室重构改善明显，血浆BNP水平下降显著；未行PCI治疗的患者死亡率高。

Impact of percutaneous coronary intervention on plasma brain natriuretic peptide levels and ventricular remodeling in patients with acute right ventricular myocardial infarction combined with left ventricular inferior wall or anterior wall myocardial infa

Objective To investigate the impact of percutaneous coronary intervention (PCI) on plasma brain natriuretic peptide (BNP) levels and ventricular remodeling in patients with acute right ventricular myocardial infarction (ARVMI) combined with left ventricular inferior wall myocardial infarction (LVIWMI) or anterior wall myocardial infarction (LVAWMI). Methods Totally 207 patients with ARVMI combined with LVAWMI or LVIWMI were included in the present study. The patients were divided into two groups: ARVMI plus LVIWMI (n=159) and ARVMI plus LVAWMI(n=48). The plasma BNP levels, myocardium enzyme, hemodynamic indices and coronary artery disease were compared between the two groups. The plasma BNP level, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDd) were observed in patients before and after primary PCI or delayed PCI treatment and in those receiving no PCI. Results We found that the plasma BNP level, CK and CK-MB peak value, pulmonary artery systolic pressure, degree of infarct-related coronary artery and incidence of 2-branch involvement in ARVMI plus LVAWMI group were significantly higher than those in the ARVMI plus LVIWMI group (P<0.05). The plasma BNP levels and LVEDd were significantly decreased in patients after treatment with primary PCI or delayed PCI (P<0.05), and the plasma BNP level was significantly lower and improvement of LVEDd was significantly greater in patients receiving primary PCI(P<0.05). Patients receiving no PCI treatment had a significantly higher mortality compared with those receiving primary or delayed PCI(P<0.05). ConclusionPatients with ARVMI plus LVAWMI have higher level of BNP and more severe coronary symptoms. There are noticeable improvement of ventricular remodeling in patients receiving primary PCI, and they also have greatly decreased plasma BNP level.