急性心肌梗死患者直接PCI术后ST段回落不良的原因及其临床结果分析

Reasons and outcomes of bad ST-segment resolution after primary percutaneous coronary intervention for acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者直接经皮冠状动脉介入治疗(PCI)术后ST段回落不良的原因及其临床结果。方法入选47例ST段抬高型AMI患者行急诊冠脉造影及PCI术,术前常规检查心电图、血生化指标并予抗栓治疗,复查术后1h心电图并随访1个月内心血管事件(MACE)、室壁运动异常积分及左室射血分数。结果按术后1h抬高的ST段下降≥50%与<50%将病人分为ST段回落良好组与ST段回段不良组,与ST段回落良好组相比,ST段回落不良组合并糖尿病、冠脉内血栓负荷重、冠脉完全闭塞、无侧枝循环建立、术后未恢复TIMI3级血流的比例均明显增高(P<0.05或P<0.01),起病至球囊开通血管时间显著延长(P<0.05),MACE发生率及室壁运动异常积分明显升高(P<0.01),而左室射血分数则显著降低(P<0.05)。结论多种因素阻碍了AMI患者直接PCI术后ST段的回落并导致不良临床结果,了解上述危险因素有助于医生在直接PCI术中采取正确应对措施。

[Objective] To explore the reasons and outcomes of bad ST-segment resolution （STR） after primary percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI）. [Method] 47 patients with acute ST-segment elavation myocardial infarction who underwent coronary arteriography and PCI were enrolled. Electrocardiogram （ECG）, blood constituent and anti-thrombus therapy were routinely performed before PCI. ECG was reviewed 1 hour after PCI, the main cardiovascular events （MACE） within 1 month after PCI were followed up and the ventricular wall motion abnormality （VWMA） index and the left ventricular ejection fraction （LVEF） were evaluated with echocardiography at 1 month after PCI. [Result] According to the degree of STR the patients were divided into good STR （≥50%） group and bad STR （〈50%） group. The incidence of diabetes mellitus, high burden thrombus formation, cutoff pattern of occlusion, no collateral circulation, failure to achieve Thrombolysis In Myocardial Infarction （TIMI） 3 flow in the infarct-related arteries and longer time of onset-to-balloon were significantly higher in bad STR group than that in good STR group （P 〈0.05 or P 〈0.01 respectively）. Accordingly, the bad STR group had higher MACE rate and VWMA index （P 〈0.01 respectively） and lower LVEF （P 〈0.05） than that of good STR group. [Conclusion] Several factors could prevent STR after PCI for AMI. Awareness of these risk factors may be useful to clinicians to diagnose and treat patients property undergoing primary PCI.