急性心肌梗塞前心绞痛对其急诊冠脉介入术后再流现象的影响

目的:探讨梗塞前心绞痛(PIA)对急性心肌梗塞(AMI)患者经皮冠状动脉介入治疗(PCI)后无再流现象的影响。方法:230例行急诊PCI的AMI患者依其是否发生再流现象分为两组:无再流组(25例)和再流组(205例)。监测再灌注心律失常、心肌酶谱和C反应蛋白(CRP)变化;超声心动图测定心功能,观察室壁瘤、心力衰竭发生率和住院病死率。结果:无再流组PIA发生率显著低于再流组(P<0.01);而前壁梗塞的发生率高于再流组(P<0.01),CRP值明显高于再流组(P<0.05);再灌注心律失常发生率、肌酸激酶同工酶峰值和水平均显著高于再流组(P<0.01)。左室射血分数显著低于再流组(P<0.05);心力衰竭、室壁瘤发生率和死亡率均高于再流组(P<0.01)。而多元回归分析结果显示,缺乏PIA是发生无再流现象的独立预测因素(OR=3.71,P=0.01)。结论:缺乏PIA是发生无再流现象的独立预测因素。

Effects of preinfarction angina on no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction

Objective:To evaluate effects of preinfarction angina(PIA) on no-ref1ow phenomenon after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI).Methods:A total of 230 patients with first AMI were divided into no-ref1ow group(n=25) and reflow group(n=205).All patients underwent PCI within 12 h after onset of AMI.No-reflow phenomenon was defined as TIMI grade 2 f1ow or 1ess without apparent residual stenosis in infarct-related artery(IRA).Reperfusion arrhythmia was observed.Left ventricular function was assessed by UCG.Results:(1) Patients with no-ref1ow had a significantly lower PIA incidence(P<0.01),a higher rate of anterior infarction(P<0.01),higher level of C-reactive protein(P<0.05),a higher rate of reperfusion arrhythmia and significantly higher peak of creatine kinase isozyme than those of reflow group(P<0.01);(2) Patients with no-reflow had lower left ventricular ejection fraction(P<0.05) and had higher incidence of ventricular aneurysm,heart failure and mortality than those of reflow group(P<0.01);(3) Multivariate Logistic ana1ysis showed that absence of preinfarction angina was a major independent determinant of no-reflow phenomenon(OR=3.71,P=0.01).Conclusion:The absence of preinfarction angina is an independent predictor of no-reflow phenomenon.