冠状动脉病变形态学与急性心肌梗死直接经皮冠状动脉介入治疗后无复流的关系

The relationship between morphology of coronary artery pathological changes and no-reflow phenomenon after primary percutaneous coronary intervention

目的探讨冠状动脉病变形态学与急性ST段抬高型心肌梗死(STEAMI)患者直接经皮冠状动脉内介入治疗(PCI)后无复流的关系。方法回顾性分析自2001年3月-2004年11月410例STEAMI患者直接PCI后的临床和造影资料,无复流患者51例,由其余359例直接PCI后TIMI3级冠脉前向血流者中随机抽取60例作为正常血流组。结果无复流的发生率为12.44%。分析表明:两组在几乎完全闭塞、血栓、钙化、长病变等造影发现的罪犯血管形态学改变中存在显著性差异。结论STEAMI患者如果在造影时发现罪犯血管存在几乎完全闭塞、血栓、钙化、长病变等形态学改变,则行直接PCI后无复流的发生率显著增加。

Objective To study the relationship between morphology of coronary artery pathological changes and no-reflow phenomenon after primary percutaneous coronary intervention （PCI）. Methods Clinical and angiographic data of 410 patients with with ST segment elevation acute myocardial infarction （STEAMI） after primary PCI were retrospectively analyzed between Mar 2001 and Nov 2004, 51 patients of them were with no-reflow phenomenon, and 60 patients were randomized from the rest 359 patients with coronary antergrade flow TIMI 3 class which were as normal flow group. Results Incidence of the no-reflow phenomenon was 12.44~, the analysis showed that significant difference were found between the two groups in the following changes of morphology such as： almost complete occlusion, thrombus, calcification and long pathological changes. Conclusion If the following morphological changes such as： almost complete occlusion, thrombus, calification, and long pathological changes were found in infarction relative artery （IRA）, incidence of no-reflow phenomenom increased after primary PCI with STEAMI.