急性心肌梗死后硝酸甘油介入心肌显像预测血管重建术后心肌灌注改善的研究

Evaluation of Myocardial Perfusion Improvement After Coronary Revascularization in Patients With Acute Myocardial Infarction

目的 :探讨硝酸甘油介入心肌显像预测急性心肌梗死血管重建术后心肌灌注改善的准确率。方法 :对 2 4例急性心肌梗死患者进行 7天或 11天随访行硝酸甘油介入99m锝—甲氧基异丁基异腈 (99mTc MIBI)心肌显像与经皮冠状动脉腔内成形术 (PTCA)。采用肉眼观察法与放射性计数法进行预测血管重建术后心肌灌注改善分析。术后 3个月随访复查静息99mTc MIBI心肌显像 ,作为判断硝酸甘油介入血管重建术后心肌灌注改善的金标准。结果 :硝酸甘油介入99mTc MIBI心肌显像肉眼观察法与放射性计数法对预测血管重建术后心肌灌注改善的敏感性分别为 5 7%与 65 % ,特异性各为 89%与 90 % ,准确率各为 66%与 73 % ,阳性预测值各为 91%与 93 % ,阴性预测值各为49%与 5 4%。结论 :硝酸甘油介入99mTc MIBI心肌显像是预测心肌梗死血管重建术后早期心肌灌注改善较为准确的方法。

Objective: To study predictive accuracy of myocardial perfusion improvement after coronary revascularization by nitroglycerin myocardial imaging.Methods: Nitroglycerin (NTG) technetium- 99m hexakis-2- methoxylisobutylisonitrile ( 99m Tc-MIBI) myocardial imaging and percutaneous transluminal coronary angioplasty (PTCA) were performed in 24 patients within 1 week after the onset of acute myocardial infarction.Visual and radioactive scaling methods were used for predictive analysis on myocardial perfusion improvement after coronary revascularization.Rest 99m Tc-MIBI myocardial imaging was performed at 3 months after PTCA to assess myocardial perfusion improvement,which was considered as golden standard for prediction of myocardial perfusion improvement after PTCA by NTG.Results: Predictive sensitivity,specificity,accuracy,positive and negative predictive values by NTG 99m Tc-MIBI visual and radioactive scaling analysis were 57% vs 65%,89% vs 90%,66% vs 73%,91% vs 93% and 49% vs 54%,respectively(All p >0.05).Conclusion: NTG 99m Tc-MIBI myocardial imaging was an accurate method for prediction of early myocardial perfusion improvement after PTCA.