急性心肌梗死后冠状动脉自发再通的预测因素及其临床意义

Predictive factors and clinical significance of spontaneous recanalization of the infarct related artery in acute myocardial infarction

目的 探讨急性心肌梗死 (AMI)后冠状动脉自发再通 (SR)的预测因素及其临床意义。方法 行选择性冠状动脉造影和左室造影的 2 16例首次AMI患者 ,分组比较SR对肌酸激酶 (CK)峰值浓度、左室功能和临床转归的影响 ,并分析SR的预测因素。结果 ①分组 :有自发再通的A组 5 7例 (2 6 4 % ) ,无自发再通的B组 15 9例 (73 6 % )。②入院时Killip心功能分级A组低于B组 (P <0 0 5 ) ,CK及CK -MB峰值浓度A组显著低于B组 (P <0 0 5 )。③左室射血分数A组明显低于B组(P <0 0 1) ,而室壁运动记分则A组明显低于B组 (P <0 0 1)。④PTCA术后TIMI血流 3级的比例A组显著高于B组 (P <0 0 5 ) ;总的院内心脏事件发生率A组显著低于B组 (P <0 0 5 )。⑤梗死前心绞痛 (P <0 0 1)、发病至治疗间期 (≤ 4h) (P <0 0 5 )和梗死相关动脉的侧支循环 (0～ 1级 ) (P <0 0 5 )是SR的独立预测因素。结论 AMI后冠状动脉自发再通的患者左室功能和临床预后较好 ,其发生可能与梗死前心绞痛和发病至治疗的间期有关。

Objective To investigate the predictive factors and clinical significance of spontaneous coronary recanalization (SR) in acute myocardial infarction. Methods 216 patients with the first acute myocardial infarction underwent selective coronary angiography and left ventriculography. The predictive factors and clinical significance of SR were analyzed retrospectively. Results ①In the 216 patients, there were 57 with SR (group A, 26.4%) and 159 without SR (group B, 73.6%). ②The Killip class at baseline was significantly lower in group A than in group B (P<0 05), and the peak creatine kinase (CK) and CK-MB fraction were significantly lower in group A than in group B (P<0 05). ③The left ventricular ejection fraction was higher and the wall motion Cortina score was lower in group A than those in group B (P<0 01). ④More patients got TIMI-3 flow after angioplasty in group A than those in group B (P<0 05). More patients occurred cardiac events during hospital stay in group A than those in group B (P<0 05). ⑤From a variety of baseline characteristics and angiographic results, multivariate analysis identified preinfarct angina (RR 2.39, 95% CI 1.40 to 4.60,P<0 01), interval from symptom to medical therapy ≤4 h (RR 1.76,95% CI 1.10 to 2.80, P<0 05) and poor collaterals (RR 1.98, 95%CI 1.02 to 3.87, P<0 05) as independent factors relating to SR. Conclusion Spontaneous coronary recanalization in acute myocardial infarction was associated with better cardiac function and clinical prognosis. Its occurrence might be related to preinfarct angina and interval from symptom to medical therapy.