心肌灌注分级和心电图变化与急性心肌梗死2年预后的相关分析

Prediction of 2-year outcome by combining TIMI myocardial perfusion grading with sum ST segment resolution in patients with acute myocardial infarction

目的联合应用TIMI心肌灌注分级(TMP)、心电图ST段抬高总和回落百分比(sumSTR)评价急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)后心肌灌注程度,探讨其对2年预后的预测价值.方法 77 例连续AMI患者急诊PCI后,即刻联合应用TMP与sumSTR方法评价心肌灌注程度;随访术后2年内死亡、再梗死、再次血运重建、心绞痛、心力衰竭事件;超声心动图测定术后72 h、2年时左心室舒张末期内径(LVEDD)及射血分数(LVEF).结果 Cox多因素分析显示 TMP 分级为0～1级合并sumSTR<30% 为 PCI 术后2年心脏事件的独立危险因子(RR=13.186,95 % 可信区间 2.149～80.917,P=0.005);心肌灌注不良组术后2年LVEDD增大值(7.1 mm±1.9mm)大于心肌灌注良好组(1.5 mm±1.2 mm)(t=15.777,P<0.01);卡方检验显示TMP与sumSTR方法联合应用的评价结果与PCI术后2年心功能水平密切相关(χ2= 50.58,P<0.01).结论 TMP与sumSTR联合应用对AMI患者行急诊PCI术后2年的心脏事件和心功能有一定的预测价值.

Objective To evaluate the value of combining TIMI myocardial perfusion （TMP） grading with sum ST segment resolution （sumSTR） in prediction of the 2-year outcome and heart function in patients with acute myocardial infarction （AMI） after emergency percutaneous intervention （PCI）. Methods Seventy-seven consecutive patients of AMI with elevated ST segment, 62 males and 15 females, aged 63 ±12 （30-91）, underwent PCI. TMP grading was used in combination of electrocardiography to calculate the sumSTR so as to evaluate the effect of myocardial reperfusion. The patients with TMP grade 2-3 and sumSTR ≥30% were included in the group of better perfusion, and those with the TMP grade 0 - 1 and sumSTR 〈 30% were included in the group of lower perfusion. The cardiac events, including death, reinfarction, revasularization, angina pectoris, and heart failure were recorded. The left ventricular end-diastolic dimension （LVEDD） and left ventricular ejection fraction （LVEF） were measured by echocardiography 72 hours and 2 years after the PCI. Results There were 37 patients in the lower perfusion group and 39 patients in the better perfusion group. Cos regression showed that TMP grade 0-1 associated with sumSTR 〈 30% was an independent factor for 2-year cardiac events （RR = 13. 186, 95% CI 2. 149-80. 917, P = 0. 005）. The LVEDD 2 years after PCI was 60 mm ±4 mm, significantly higher than that 72 hours after PCI （53 mm ±4 mm. P 〈0.01 ） in the lower perfusion group. The LVEDD increased by 7.1 mm ± 1.9 mm two years after PCI in the lower perfusion group, significantly more than that in the better perfusion group （1.5 mm ＋ 1.2 mm, P 〈0.01 ）. The myocardial perfusion after PCI was closely correlated with the extent of heart function improvement 2 years after （ x^2= 50. 58, P 〈 0.01 ）. Conclusion TMP grading combined with sumSTR helps predict the 2-year outcome and heart function in the patients with AMI after emergency PCI.