急性ST段抬高型心肌梗死患者PCI术后冠脉无复流研究进展

Current knowledge of no-reflow phenomenon after PCI in patients with acute ST-segment elevation myocardial infarction

急性ST段抬高型心肌梗死(STEMI)是严重威胁人类生命健康的心血管疾病,起病凶险且死亡率高。随着经皮冠状动脉内介入(PCI)手术的开展,短期内尽快开通闭塞血管、恢复远端心肌血流灌注,能够显著降低STEMI患者病死率、改善临床预后。然而,相当部分STEMI患者PCI术后出现冠脉内无复流(CNR)现象,极大地阻碍了其临床治疗效果和远期预后改善。目前,CNR的病理机制尚未完全清楚,临床上亦缺乏可靠的预测指标和治疗措施。部分药物和手术操作显示出一定预防和改善PCI术后CNR的疗效,但远期心血管获益尚有待研究。本文就CNR的定义与诊断、相关危险因素、预测评估及防治措施进行回顾,以提高临床对于STEMI患者PCI术后CNR的认知与重视,并对未来研究方向进行展望。

Acute ST-segment elevation myocardial infarction(STEMI)is a catastrophic cardiovascular disease that threatens human health and life,with dangerous onset and high mortality.With the development of percutaneous coronary intervention(PCI),the revascularization of occluded arteries and the restoration of distal myocardial perfusion in short term can significantly reduce the mortality of STEMI patients and improve their clinical outcomes.However,a considerable number of STEMI patients may suffer from coronary no-reflow(CNR)phenomenon after revascularization,which greatly hinders the improvement of clinical therapy and long-term prognosis.Currently,the pathological mechanism of CNR is still unclear and there is a lack of reliable clinical predictors or treatment measures.Some medications and surgical procedures have shown certain efficacy in preventing and improving CNR after PCI,but the long-term cardiovascular benefits remain unknown.In this review,we focus on the definition and diagnosis,risk factors and predictors,and prevention and treatment measures,thus to improve clinical attention to CNR after PCI in STEMI patients and also to forecast future research directions.