梗死相关动脉自发再通的临床意义

The clinical significance of spontaneous recanalization of infarct related artery

目的 探讨梗死相关动脉自发再通 (spontaneousrecanalization ,SR)的临床意义。方法 自1996年 1月至 2 0 0 2年 9月共有 6 17例急性心肌梗死 (AMI)患者进行了急诊冠脉造影 ,其中符合SR定义者共 118例。 118例患者中有 6 9例施行了直接PTCA。为使研究有可比性 ,将 6 9例SR (SR组 )与 4 4 2例无SR而直接PTCA患者 (无SR组 )进行了比较研究。结果 SR组入院时心功能Killip分级显著低于无SR组(2 9%vs 16 9% ,P =0 0 0 2 ) ,SR组的梗死前心绞痛显著多于无SR组 (6 9 5 %vs 2 9 8% ,P <0 0 0 1)。SR组就诊至球囊扩张时间较无SR组有降低趋势 ,但差异无显著性意义。SR组的CK、CK MB峰值均显著低于无SR组。SR组充血性心力衰竭比例显著低于无SR组 (2 9%vs 15 8% ,P =0 0 0 4 )。SR组 6个月时的EF值亦显著高于无SR组〔 (6 4 3± 7 8) %vs (5 5 6± 6 4 ) % ,P =0 0 3〕。结论 存在SR的AMI患者心肌梗死范围小 ,急性期和直接PTCA后 6个月的心功能均得到保护。

Objective To study the clinical significance of the spontaneous recanalization (SR)of infarct related artery. Methods Sixty nine patients with SR who underwent percutaneous transluminal coronary angioplasty (PTCA) between January 1996 and September 2002 were enrolled, and 442 patients without SR who received PTCA during the same period were selected as controls.Occurrence of death, reinfarction, and congestive heart failure within 6 months after acute myocardial infarction were compared.Results Killip classes of the heart function in SR group was significantly lower than those in control group(2.9% vs 16.9%,P=0.002). The peak values of CK and CKMB were lower in SR group than in control group. Congestive heart failure occurred more frequently in control group than in SR group at 6 month follow-up 2.9% vs 15.8%;P=0.004). The ejection fraction was significantly higher in SR group than in control group〔(64.3%±7.8)% vs (55.6%±6.4)%,P=0.03〕.Conclusion SR in acute myocardial infarction is associated with smaller infarct size and better heart function during acute period and 6 months after primary coronary angioplasty.