摘要
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.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2006年第17期2651-2653,共3页
China Journal of Modern Medicine
关键词
急性心肌梗死
心电描记术
心肌再灌注
经皮冠状动脉血运重建术
acute myocardial infarction
electrocardiography
myocardial reperfusion
percutaneous coronary intervention