CTFC在急性心肌梗死PCI中的价值及腺苷干预的研究

The Value of CTFC in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention and Effect of Adenosine Interference on CTFC

目的评价急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)中校正的心肌梗死溶栓治疗临床实验(TIMI)帧数(CorrectedTIMIFrameCount,CTFC)的价值及应用腺苷前后的变化。方法CTFC测定以造影剂充盈冠状动脉开始至冠状动脉远端某一解剖标志显影之间的帧数来表示,以<30帧为血流正常者,≥30为血流缓慢者。67例AMI后10～15d行冠状动脉造影和介入治疗,PCI前后分别经冠状动脉内注射腺苷注射液20mg,并观察CTFC的变化,PCI后均行二维超声心动图测定左心室射血分数(LVEF),并观察住院期间的主要心脏不良事件(MACE)。结果67例AMI患者CTFC为12～93帧,平均42.23±20.41帧,PCI术后的CTFC较术前明显减少(P<0.01),各梗死相关动脉和血流缓慢者PCI前应用腺苷后的CTFC较腺苷应用前均明显减少(P<0.05);血流正常者PCI治疗前、后以及血流缓慢者PCI后冠脉内应用腺苷前、后比较均无明显差异(P>0.05);血流正常者LVEF明显高于血流缓慢者(P=0.001),MACE发生率血流缓慢者明显高于血流正常者(P<0.05)。左心室射血分数和CTFC呈负相关趋势(γ=-0.21,P=0.002)。结论CTFC测定结果重复性好,与病人的心功能、MACE发生率相关性良好,不受检测者临床经验的限制,评价梗死相关动脉血流优于TIMI血流分级。而PCI前后冠脉内腺苷应用可明显降低CTFC,减少无复流或慢复流现象。

Objective To assess the value of corrected TIMI frame count(CTFC) in patients with acute myocardial infarction(AMI) underwent primary percutaneous coronary intervention(PCI) and the change of CTFC before and after adenosine interference. Methods CTFC was defined as the number of cineframes from coronary filling with radiographic reagent to visualization of distal coronary landmark in the infarct-related artery. Normal antegrade flow was <30 frames, and slow antegrade flow was ≥30 frames. Quantitative angiography and PCI were performed in 67 patients 10～15 days after AMI. 20mg adenosine was injected by coronary before and after PCI, and the change of CTFC was observed. LVEF was measured with UCG after PCI, and major adverse cardic events(MACE) was observed during hospitalization. Results CTFC of 67 patients with AMI was 12～93(42.23±20.41)frames.CTFC after PCI significantly decreased compared with before PCI (P<0.01).CTFC in the infarct-related artery significantly reduced after administering adenosine compared with before using adenosine(P<0.05), and CTFC of the patients with slow antegrade flow after using adenosine significantly reduced as well(P<0.05). CTFC of the patients with normal antegrade flow before and after PCI was not significantly different(P>0.05), and CTFC of the patients with slow antegrade flow, who underwent PCI, was not significantly different before and after administering adenosine. LVEF of the patients with normal antegrade flow was significantly higher than that of the patients with slow antegrade flow(P=0.001). MACE of the patients with slow blood flow were obviously higher than that of the patients with natural blood flow(P<0.05). LVEF was negatively correlated with CTFC(γ=-0.21,P=0.002). Conclusion The reproducibility of CTFC was good, and CTFC was closely related with AMI patients heart function and MACE frequency. CTFC was better than thrombolysis in myocardial infarction (TIMI) in evaluating blood flow in the infarct-related artery. Administering adenosine in coronary could obviously reduce CTFC and no-reflow or slow-reflow phenomenon.