急诊经皮腔内冠状动脉成型术(PTCA)无复流现象对预后的影响

Clinical significance of no-reflow phenomenon observed in emergency myocardial infarction with percutaneous transluminal coronary angioplasty.

目的:无复流现象被定义为经皮腔内冠状动脉成型术(PTCA)或支架植入后TIM I血流≤2级,但冠脉内无机械性阻塞。本研究探讨急诊PTCA中无复流现象的临床意义。方法:我们回顾性分析了2001年1月至2002年1月就诊于同仁医院的53例[男37例,女16例,年龄(54±12.35)岁]初发急性心肌梗死(AM I)行急诊PTCA的患者。病例被分为无复流组(18例,TIM I≤2级)和PC I后冠脉血流正常组(35例,TIM I3级),随访6个月,观察有无心脏病性猝死和非致命性心脏事件。组间差别采用t检验或x2检验。结果:无复流组发生充血性心衰(P<0.05)、恶≤2级性心律失常(P<0.05)、再发心绞痛(P<0.05)、心脏性猝死(P<0.05)高于冠脉血流正常组。无复流组6个月后左室射血分数显著低于冠脉血流正常组。结论:无复流现象强烈提示AM I预后不良。但需进一步的大规模临床试验验证。

Objective： Tostudy the clinical significance of no- reflow phenomenon observed in acute myocardial infarction （AMI） with percutaneous transluminal coronary angioplasty （PTCA）. Background Angiographic noreflow phenomenon, a reduced coronary antegrade flow （Thrombolysis in Myocardial Infarction [ TIMI] flow grade≤2） without mechanical obstructoon after recanalization, predicts poor lwft ventricular（LV） functional recovery and survival in the early phase of AMI. Methods：The clinical significance of the angiographic no - reflow phenomenon was evaluated in 53 patients with AMI treated by PTCA. On the basis of the post - PTCA angiograms, patients were divided into two groups ： normal angiogram （ group 1, n = 35 ）, no - reflow （ group2, n = 18 ）. Results ： Regional wall motion in the chronic phase was depressed in groups 2 compared with group 1. The proportion of the area of the transmural infarction to that of the total infarction determined by scintigraphy was higher in group 2 than that in group 1. A significantly higher incidence of myocardial rupture and of death resulting from cardiac causes was observed in group 2 compared with group 1. Conclusions： The severity of this phenomenon immediately after an emergency PTCA correlated well with the severity of myocardial damage, with patients having severe no-reflow showing the poorest prognosis.