急性心肌梗死自发再灌注预测因素及其短期预后

Predictive factors and short-term prognosis of acute myocardial infarction patients with spontaneous reperfusion

目的 研究急性ST段抬高型心肌梗死自发再灌注的临床预测指标及短期预后.方法 连续入选2009年1月到2010年8月的207例确诊急性ST段抬高型心肌梗死并行急诊冠状动脉造影检查的患者,将血流TIMI 3级的患者定义自发再灌注组（SR）,血流TIMI 0 ～2级定义为非自发再灌注组（NSR）.比较2组冠状动脉造影前心电图ST段回落及症状缓解对自发再灌注的预测价值,同时比较2组的住院期间心脑血管事件发生率.结果 SR组共38例（18.4％）,NSR组共169例（81.6％）.SR组急诊造影前心电图ST段回落＞50％的患者比例明显高于NSR组（42.1％比14.8％,P＜0.001）,SR组急诊冠状动脉造影前症状较最严重时症状缓解＞80％的患者比例较NSR组亦明显升高（53.3％比9.0％,P＜0.001）;心电图ST段回落＞50％预测自发再灌注的敏感度42.1％,特异度85.2％,阳性预测值39.0％,阴性预测值86.7％;症状缓解＞80％预测自发再灌注敏感度53.3％,特异度91.0％,阳性预测值55.2％,阴性预测值90.3％;若采用症状缓解80％及ST段回落＞50％联合标准,则敏感度13.3％,特异度98.6％,阳性预测值为66.7％,阴性预测值为84.5％.若采用ST段完全回落且症状缓解＞80％联合标准,则敏感度13.3％,特异度100％,阳性预测值100％,阴性预测值84.7％.冠状动脉造影SR组的住院期间心脑血管事件发生率与冠状动脉造影NSR组相比为13.2％和25.4％ （P =0.285）.结论 症状的缓解及心电图的回落对急性心肌梗死自发再灌注有一定的预测价值;SR组住院期间心脑血管事件发生率较NSR组有降低的趋势.

Objective To investigate the clinical implications of different evaluation methods and the short-term prognosis of spontaneous reperfusion in ST-segment elevation myocardial infarction. Methods Two hundred and two consecutive ST-segment elevation myocardial infarction patients underwent coronary angiography from January 2009 to August 2010 in Xuanwu Hospital were enrolled. Patients were divided into spontaneous reperfusion （SR, TIMI flow grade 3 identified by coronary angiogram ） group and nonspontaneous reperfusion （NSR, TIMI flow grade 0-2 identified by coronary angiogram ） group. We analyzed the predictive value of symptoms and ECG changes in spontaneous reperfusion in acute myocardial infarction and the incidence of cardio-cerebrovascular events during hospitalization. Results SR occurred in 38 （ 19.4% ） patients and NSR in 169 （81.5%） patients. 42. 1% of the patients in SR group and 14. 8% in NSR group had more than 50% recovery of elevated ST segment （ P 〈0. 00l ）. 53.3% of the patients in SR group and 9. 0% in NSR group had more than 80% of symptoms release （P 〈 0. 001 ）. The sensitivity,specificity, positive predictive value, negative predictive value of ST segment recovery 〉 50% were 42. 1%, 85.2% , 39.0% and 86. 7% , respectively, and those of symptoms release 〉80% were 53.3%, 91.0% , 55.2% and 90. 3%, respectively. The sensitivity,specificity, positive predictive value, negative predictive value of the combination of ST segment recovery 〉 50% and symptoms release 〉 80% were 13.3% , 98. 6%, 66. 7% and 84. 5%, respectively. The incidence of short-term cardio-eerebrovascular events between SR group and NSR group were similar（ 13.2% vs. 25.4% , P = 0. 285）. Conclusions Symptom relief and ST segment recovery have certain predictive value of SR. The incidence of short-term cardiocerebrovascular events has a trend of decrease in SR patients.