衰减斑块对急性心肌梗死患者经皮冠状动脉介入治疗围术期的影响研究

The influence of attenuated plaque on perioperative period of percutaneous coronary intervention in patients with acute myocardial infarction

目的对急性心肌梗死（AMI）患者行血管内超声（IVUS）探测衰减斑块，并探讨衰减斑块对经皮冠状动脉介入治疗（PCI）围术期的影响。方法入选AMI住院患者85例，作冠状动脉造影（CAG）及IVUS检查．必要时行支架植入术。根据IVUS是否探测到衰减斑块将患者分为衰减斑块组和无衰减斑块组，比较两组患者围术期IVUS影像学结果、心肌梗死溶栓（TIMI）后血流分级及术后肌酸激酶同工酶（CK-MB）峰值。结果85例AMI患者中35例（41．2％）检测到衰减斑块（衰减斑块组），50例（58．8％）未发现衰减斑块（无衰减斑块组）；两组间年龄、性别、危险因素差异无统计学意义（P〉0．05）。ST段抬高型心肌梗死（STEMI）患者中有衰减斑块比例明显高于非ST段抬高型心肌梗死（NSTEMI）患者（P=0．01）。衰减斑块组和无衰减斑块组间CAG时TIMI血流分级无统计学差异（P〉0．05），但球囊扩张后衰减斑块组TIMI 0～2级比例明显高于无衰减斑块组（P=0．003）。衰减斑块组患者术后CK-MB值上升患者比例和CK-MB峰值均显著高于非衰减斑块组（P〈0．01）。结论衰减斑块可导致PCI术后无复流和慢血流发生率升高，更常见于STEMI患者；衰减斑块呈显著高危性，可用于预测患者术后CK-MB值升高程度。

Objective To detect attenuated plaque by using intravascular ultrasound （IVUS） in patients with acute myocardial infarction （AMI） and to investigate the influence of attenuated plaque on perioperative period of percutaneous coronary intervention （PCI）. Methods Coronary angiography and IVUS were performed in 85 hospitalized patients with AMI, additional implantation of stent was employed when necessary. According to the presence or absence of attenuated plaque determined by IVUS, the patients were divided into attenuated plaque group （n=35） and non-attenuated plaque group （n=50）. The perioperative IVUS findings, the blood flow classification after myocardial infarction thrombolysis （TIMI） and the postoperative peak value of creatine kinase MB （CK-MB） determined were compared between the two groups. Results Among the 85 AMI patients, attenuated plaque was detected in 35 （41.2%） and no attenuated plaque was found in 50（58.8%）. No statistically significant differences in the age, sex and risk factors existed between the two groups （P〉0.05）. The proportion of having attenuated plaque in patients with ST segment elevation myocardial infarction （STEMI） was obviously higher than that in patients with non-STEMI （P〈 0.01 ）. In performing coronary angiography, the difference in TIMI blood flow classification between the two groups was not statistically significant （P〉0.05）, but after balloon dilatation the TIMI grade 0-2 in the attenuated plaque group was strikingly higher than that in the non-attenuated plaque group （P=0.003）. After PCI, the proportion of patients with elevated CK-MB value and higher peak value in the attenuated plaque group was remarkably higher than those in the non-attenuated plaque group （P〈0.01）. Conclusion The resuhs of this study indicate that attenuated plaque can increase the incidence of no-reflow and slow reflow after PCI, which is more often seen in STEMI patients. The attenuated plaque carries significantly high risk, and the presence of attenuated plaque is helpful in predicting, the elevated extent of CK- MB value after PCI.