经介入治疗即刻前向心肌梗死溶栓治疗临床试验3级血流患者左心室功能不全的相关因素

Correlation Factors for Left Ventricular Dysfunction of Acute ST Segment Elevation Anterior Myocardial Infarction After Primary Percutaneous Coronary Intervention With Thrombolysis in Myocardial Infarction 3 Grade

目的:探讨急性ST段抬高性前壁心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)即刻前向心肌梗死溶栓治疗临床试验(TIMI)3级血流患者左心室功能不全的相关因素。方法:分析我院2004-01至2009-01的273例急诊PCI患者的临床和冠状动脉造影资料,STEMI直接PCI即刻前向血流TIMI3级心功能不全患者52例,为心功能不全组,由其余前壁STEMI直接PCI即刻前向血流TIMI3级心功能正常的患者中随机抽取60例,为心功能正常组,运用logistic回归分析左心室功能不全的相关因素。结果:STEMI直接PCI即刻前向血流TIMI3级心功能不全的发生率为19%。心功能不全组与心功能正常组比较,糖尿病、症状开始至再灌注的时间、梗死前心绞痛、心肌灌注显影血流分级(TMBG),室壁运动积分(WMS),室壁运动积分指数(WMSI)差异有统计学意义(P<0.05～0.001)。Logistic多元回归分析表明:梗死前心绞痛、心肌灌注显影血流分级,室壁运动积分和室壁运动积分指数与STEMI直接PCI即刻前向血流TIMI3级患者左心室功能不全相关(P<0.05)。结论:STEMI直接PCI即刻前向血流恢复TIMI3级,心肌灌注显影血流分级、微血管损伤和室壁运动异常可能会促使左心室功能不全的形成;梗死前心绞痛有助于微循环血流增加,可能减少左心室功能不全的发生;而冠心病的危险因素与左心室功能不全没有相关性。

Objective： To elucidate the relative factors to left ventricular dysfunction of acute ST segment elevation anterior myocardial infarction（STEMI） after primary percutaneous coronary intervention （PCI）with thrombolysis in myocardial infarction 3 grade （TIMI）. Methods： A total of 112 patients with acute ST segment elevation anterior myocardial infarction after PCI were analyzed. 52 patients with anterior myocardial infarction were defined as left ventricular dysfunction group; and Control group contained 60 patients of anterior myocardial infarction with coronary antergrade flow TIMI 3 class, after primary PCI, the patients＇ left ventricular function recovered to normal. Multiple logistic regression analysis was used to identify the independent correlation factors of left ventricular dysfunction. Results： The occurrence of left ventricular dysfunction was 19%. Univariate analysis showed that diabetes mellitus, symp- tom onset to reflow time, pre-infarction angina, thrombolysis in myocardial infarction myocardial blush grade（TMBG）, wall motion score（WMS） and wall motion score index（WMSI）were related to left ventricular dysfunction（P =0. 049）. However, multiple logistic regression analysis indicated that pre-infarction angina, TMBG, WMS and WMSI were the correlation factors of left ventricular dysfunction（ P = 0. 040 ）. Conclusion ： With patients recovering blood flow TIMI 3 grade after primary PCI, lower TMBG, severe micro vascular injury and abnormal wall motion could promote left ventricular dysfunction. Pre-infarction angina might improve micro vascular function and therefore attenuated left ventricular dysfunction. However, the risk factors for coronary heart disease had no correlation with left ventricular dysfunction.