校正TIMI帧数与ST段回落评价老年急性心肌梗死患者支架成形术后心肌组织灌注

目的　观察老年急性心肌梗死 (AMI)患者冠状动脉介入 (PCI)治疗成功后 ,校正的 TIMI帧数 (CTFC)与心电图 ST段回落联合评价心肌组织水平灌注的可行性。方法　选取接受 PCI治疗后血流达 TIMI3级的老年 AMI患者 42例 ,测定 CTFC,并在术前及术后 1月分别测定室壁运动记分 (WMSI)。观察 CTFC与 WMSI之间的相关性 ,同时检查术前及术后 1 h心电图 ST段回落情况。结果　按照 CTFC将 TIMI血流 3级者分为快、慢两组 ,快 CTFC组 ST段回落程度明显优于慢 CTFC组 ;一个月后快 CTFC组的 WMSI改善程度明显优于慢 CTFC组 ,CTFC与术前、术后WMSI的差值有明显的负相关 ;快 CTFC组患者从发病到接受 PCI治疗的时间明显短于慢 CTFC组。结论　 CTFC作为一种定量、客观、简单、经济、重复性好的方法评价心肌微循环灌注情况 ,较低的 CTFC及心电图 ST段回落完全预示着良好的心功能恢复及临床预后 ,可为临床提供是否需要进一步辅助治疗的依据。

Relation of corrected TIMI frame count and ST segment resolution to myocardial tissue perfusion after acute myocardial infarction in elderly patients

Objective To explore the probability of evaluating myocardial tissue perfusion by corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) and the grade of ST segment resolution after successful percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI). Methods To measure CTFC after successful PCI in 42 elderly patients with their first AMI and analyze the extent of ST-segment-elevation resolution before and 1 hour after reperfusion therapy. To assess wall motion score index (WMSI) by two-dimensional echocardiography before and one month after PCI and study the correlation between CTFC and WMSI. Results According to CTFC the patients were divided into two groups. TIMI 3 fast group had higher percentage of complete ST resolution and lower percentage of no ST resolution compared with TIMI slow group. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group one month after operation. CTFC had a significant negative correlation with the change of WMSI before and after PCI. Elapsed time from the onset of symptoms to reperfusion in the TIMI slow group was longer than that of the TIMI fast group obviously. Conclusions CTFC was a quantitative, objective, realistic index of coronary blood flow. Combined with electrocardiogram ST-segment resolution, CTFC could predict risk for patients with successful reperfusion therapy after AMI and supply evidence for additional adjunctive treatment.