梗死前心绞痛对急性心肌梗死患者经皮冠状动脉介入治疗术后无再流现象的影响

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

目的探讨梗死前心绞痛(PIA)对急性心肌梗死(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100例首次AMI患者均在发病12h内行PCI术。所有患者按照有无无再流现象分为2组:无再流组(15例)和再流组(85例)。监测心肌酶谱和C反应蛋白(CRP)变化;放射性核素测定心功能;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);而前壁梗死的发生率高于再流组(P<0.05);肌酸激酶同工酶峰值和CRP水平均显著高于再流组(P<0.01)。无再流组放射性缺损面积显著大于再流组(P<0.01);左室射血分数显著低于再流组(P<0.01);心力衰竭、室壁瘤发生率和死亡率均高于再流组(P<0.05)。多元Logistic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=6.12,P=0.01)。结论缺乏PIA是发生无再流现象的独立预测因素,而无再流现象与心力衰竭和死亡率增高密切相关。

Objective To evaluate effects of preinfarction angina on no-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods 100 patients with first AMI were divided into no-reflow group (n=15) and reflow group (n=85). All patients underwent PCI within 12 h after onset of AMI. No-reflow phenomenon, defined as TIMI grade 2 flow or less without apparent residual stenosis in infarct-related artery (IRA). Myocardial enzyme and C-reactive protein were continuously measured; left ventricular function was assessed by radionuclideimaging; the incidence of ventricular aneurysm, heart failure and mortality in hospital were observed. Results (1)Patients with no-reflow had a significantly lower incidence of preinfarction angina (P<0.01), a higher rate of anterior infarction (P<0.05),and had significantly higher peak creatine isozyme fraction and C-reactive protein than those with reflow (P<0.01). (2) Patients with no-reflow had significantly larger myocardial infarction size (MIS) (P<0.01), significantly lower left ventricular ejection fraction (P<0.01), and had a higher incidence of ventricular aneurysm, heart failure and mortality than those with reflow (P<0.05). (3)Multivariate Logistic analysis showed that the Absence of preinfarction angina was a major independent determinant of no-reflow phenomenon (OR=6.12, P=0.01). Conclusions The Absence of preinfarction angina is a independent predictor of no-reflow phenomenon; whereas no-reflow phenomenon is closely associated with the increased incidence of heart failure and mortality.