心肌缺血预适应对经皮冠状动脉介入治疗的急性心肌梗死预后影响

目的研究心肌缺血预适应(MIP)对经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者预后的影响。方法选取186例行PCI治疗的初次ST段抬高性急性心肌梗死患者的临床资料,根据是否有MIP分为MIP阳性组(A组,n=87)和MIP阴性组(B组,n=99),回顾性分析其临床资料,比较两组梗死面积、左心室功能、冠脉病变、侧支循环、血管开通率及住院期间并发症的发生率,进而评估MIP对行PCI的AMI患者预后影响。结果 A组多支病变明显高于B组,差异具有显著性(P<0.05)。A组住院期间反映心肌梗死范围的指标CK、CK-MB峰值、QRS积分、白细胞计数和超敏C反应蛋白均较B组低;反映左心室功能的指标LVEF比B组高,室壁运动异常节段数比B组低;住院近期预后比较,心力衰竭、心源性休克、严重心律失常、再梗死、心源性死亡及复合终点事件发生率均较B组低,但差异无显著性(P>0.05)。结论心肌缺血预适应对经PCI治疗的急性心肌梗死患者预后影响不明显。

The Prognostic Influence of Myocardial Ischemic Preconditioning in Acute Myocardial Infarction with Percutaneous Coronary Intervention Treatment

Objective To study the prognostic influence of myocardial ischemic preconditioning(IPC) in acute myocardial infarction(AMI) with percutaneous coronary intervention(PCI). Methods The data of 186 cases of the initial ST-segment elevation AMI patients who were performed PCI treatment.According to whether IPC,the cases were divided into IPC-positive group(A,n=87) and IPC-negative group(group B,n=99).The clinical data were retrospective analyzed such of infarct size of two groups,left ventricular function,coronary artery disease,collateral circulation,patency rates and complications during hospitalization,and then to assess the prognostic influence of IPC in patients with AMI who underwent PCI treatment. Results The multi-vessel disease in group A was significantly higher than group B,the difference was significant(P<0.05).In group A,indicators to reflect the scope of myocardial infarction during hospitalization such as CK,CK-MB peak,QRS points,the white blood cell count and high sensitivity C-reactive protein were lower compared with those in group B;LVEF which indicate the left ventricular function was higher than in group B;The segment numbers of wall motion abnormality were more than in group B;The hospital prognosis of heart failure,cardiogenic shock,severe arrhythmias,re-infarction,cardiac death,composite end point event rate were lower than in group B,but no significant difference(P>0.05). Conclusion Myocardial IPC has not obvious inference for the prognosis of AMI patients who underwent PCI treatment.