梗死相关血管晚期开通对急性心肌梗死后左室功能的影响

目的探讨急性前壁心肌梗死后延迟经皮冠状动脉血运重建术(PCI)使梗死相关血管(IRA)开通对心梗晚期左室功能的影响。方法选择64例急性前壁、前间壁及广泛前壁Q波性心梗后病情稳定,发病10～21d冠脉造影证实左前降支完全闭塞者,依据是否接受成功PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室腔大小、左室功能和室壁活动异常,并观察6个月期间心力衰竭事件的发生情况。结果心梗后2个月两组左室射血分数(LVEF)、左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)和室壁活动异常(VWMA)积分与急性期相比无明显差异(P>0.05),急性期和2个月时两组上述各指标之间相比差异也无显著性(均P>0.05)。6个月时两组LVEF和VWMA积分与急性期和2个月相比无明显差异(P>0.05),但对照组LVEDVI和LVESVI较急性期明显增大(P<0.01,P<0.05),且与成功PCI组相比差异具有显著性(P<0.01,P<0.05)。6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组2%,但差异缺乏统计学意义(P>0.05)。结论急性前壁心梗后IRA延迟开通能明显减少心梗后晚期的左室重构,而对心梗后早期左室重构的影响不大。延迟PCI可能有利于减少心梗后远期心力衰竭事件的发生。

Effects of delayed opening of infarct-related artery on late left ventricular remodeling in patients with acute anterior myocardial infarction

Objective To assess the effect of delayed opening of the infarct-related artery ORA) by percutanous coronary intervention (PCI) on the late left ventricular remodeling after acute anterior myocardial infarction. Methods 64 patients with initial Q-wave anterior myocardial infarction and the infarct-related arteries were total occluded conformed by angiogram at 10 to 21 days after onset were divided into successful PCI group and control group (not receiving PCI or the IRA not re-opened). 2-DE was performed at acute phase (about 3 weeks), 2 and 6 months after onset of AMI respectively to detect the left ventricular function and left ventricular wall motion abnormality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. Results VWMA scores, left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic volume indexes (LVEDVI and LVDSVI) were similar in 2 groups at acute phase and 2 months. There were no differences between acute phase and 2 months in each group too. VWMA scores and LVEF did not changed at 6 months in each group compared with acute phase and 2 months (P>0.05). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group (P<0.01, P<0.05). The congestive heart failure events were taken place in 19% of patients in control group compared with 2% in successful PCI group (P>0.05). Conclusions Delayed opening of IRA in acute anterior myocardial infarction can prevent the late phase but not the early phase of left ventricular remodeling after AMI.