直接经皮冠状动脉介入治疗对有无梗死前心绞痛患者心肌存活性和心室收缩同步性的影响

Effects of direct percutaneous coronary intervention on myocardial viability and ventricular systolic synchrony in acute myocardial infarction patients with or without preinfarction angina pectoris

目的 探讨直接经皮冠状动脉介入治疗 (PCI)对有无梗死前心绞痛的急性心肌梗死 (AMI)患者心肌存活性和心室收缩同步性的近期影响。方法 87例首次 AMI患者 ,按梗死前有无心绞痛分为 3组 :A组 :无心绞痛史 30例。 B组 :梗死前 4 8h内有心绞痛史 39例。 C组 :仅在梗死前 >4 8h有心绞痛史 18例。所有患者均在发病 6 h内行直接 PCI术。术后 1周、4周行 99m Tc- MIBI心肌灌注断层显像 (SPECT)测定心肌存活性 ;术后 2周行 99m Tc心血池显像测定心室收缩同步性参数。结果 (1) B组肌酸激酶同工酶 (CK- MB)峰值显著低于 A组 (P<0 .0 1)。 (2 ) B组放射性缺损面积 (MIA)小于 A组 (P<0 .0 5 ) ;AMI后 4周与 1周比较 ,B组 MIA显著缩小 (P<0 .0 1) ,病变区放射性计数显著增加 (P<0 .0 1) ;C组和 A组前后比较均无显著差异。 (3)心功能 :B组左心室射血分数 (L VEF)高于 A组 (P<0 .0 1) ;左心室收缩同步性 :B组左心室相角程 (L PS)低于 A组 (P<0 .0 5 ) ;以上各参数 ,C组和 A组比较均无显著差异。结论 (1)首次急性心肌梗死前 4 8h内心绞痛发作可导致心肌缺血预适应 (ischemic preconditioning,IP)的产生 ,并可缩小心肌梗死面积 ,保护心功能。 (2 )直接 PCI可显著提高有

Obiective To evaluate short time effects of direct PCI on myocardial viability and ventricular systolic synchrony in acute myocardial infarction(AMI)patients with or without preinfarction angina pectoris.Methods Eighty seven patients with first AMl were divided into three groups:no previous angina(group A,n=30);preinfarction angina occurring within 48 h before onset of AMI(group B,n=39);preinfarction angina only occurring>48 h before onset of AMI(group C,n=1 8).All patients undervent direct PCI within 6 h after onset of AMI; 99m Tc MIBI SPECT was performed to detect myocardial viability at 1 and 4 weeks; 99m Tc gated cardiac blood pool image was performed to measure ventricular function and systolic synchrony at 2 weeks.Results (1)The peak creatine MB fraction was significantly lower in group B than that in group A ( P <0.01).(2)Myocardial infarction area(MIA)was less in group B than that in group A( P <0.05);MIA was significantly decreased, and radioactivity counts of MIA was significantly increased in group B at 4 weeks compared with that at 1 week( P <0.01),but there was no significant difference in group A and group C.(3)LVEF was significantly higher in group B than that in group A( P <0.01);LPS was lower in group B than that in group A( P <0.05).In all above parameters,there were no significant difference between group C and group A.Conclusion (1) Preinfarction angina within 48 h before first AMI onset have cardioprotective effects,including limiting infarct area and protecting ventricular function,the mechnism of which is IP.(2)Direct PCI could significantly improve the short time myocardial viability and ventricular systolic synchrony of AMI patients with IP.