ST段抬高的急性心肌梗死介入治疗后早期ST段下降幅度的临床意义

目的通过分析ST段抬高的急性心肌梗死(STEMI)患者接受急诊介入治疗成功后早期抬高ST段的下降幅度,评价ST段的早期恢复程度与介入术后血流恢复程度对患者心功能预测价值以及与住院期间不良事件发生率的相关性。方法连续120例首次急性ST段抬高急性心肌梗死患者,于发病12H以内接受介入治疗,测量并比较介入治疗前以及治疗后2HST段抬高振幅总和(∑STE)的下降幅度,介入后血流的恢复情况。发病后2～4周行超声心动图检查测定左心室射血分数(LVEF),评价心脏收缩功能。比较∑STE明显下降(下降≥50%,A组)与无明显下降(B组)对心功能的影响,并比较冠状动脉TIMI血流与心功能恢复的关系,以及∑STE恢复与冠状动脉血流的关系。结果两组患者情况:A组81例(67.5%),B组39例(32.5%)。A组患者的LVEF明显高于B组(58.6±7.1)%比(50.5±7.1)%,P<0.05]。KILLIP分级Ⅲ、Ⅳ级发生率A组明显低于B组(1.2%比12.8%,P<0.05)。住院期间心脏不良事件(再发急性心肌梗死、心原性休克、急性肺水肿、发病30D内死亡)的患者发生率A组显著低于B组(0%比7.7%,P<0.01)。成功介入治疗后冠状动脉造影血流达到TIMI3级者108例,占90%,其中仍有31例(28.7%)患者ST段未能很快下降50%;12例血流TIMI2级者,仅4例ST段很快下降50%,8例(66.7%)的患者ST段未能很快下降50%。发生心脏事件的3例患者均落在血流未达到TIMI3级且∑STE无明显下降的8例中。结论急性ST段抬高心肌梗死患者急诊介入治疗后早期抬高ST段下降幅度能作为心脏收缩功能和住院期间心脏不良事件发生情况的间接预测指标。∑ST段的下降比TIMI血流能更准确地反映心肌再灌注情况,是血管再通后心肌再灌注的更好指标。TIMI血流结合体表心电图的∑STE改变能更好地预测急性心肌梗死患者介入术后的临床预后。

Early ST resolution after successful primary PCI is related to a favorable outcome in ST elevated AMI patients

OBJECTIVE: To analyze the relationship between the early ST resolution magnitude and TIMI flow, MACE and the cardiac function in ST elevated AMI (STEMI) patients after successful primary PCI. METHODS: A total of 120 consecutive patients with STEMI underwent primary PCI within 12 hours after the onset of chest pain were enrolled in this study, the ST segment resolution was calculated and the patients were divided into group A (n = 81, Sigma STE resolved > or = 50%) and group B (n = 39, Sigma STE resolved < 50%). TIMI flow after PCI, clinical events up to 30 days post PCI and cardiac function 30 days post PCI were assessed. RESULTS: LVEF was higher in group A than that of group B (58.6% +/- 7.1% vs. 50.5% +/- 7.1%, P < 0.05). There are fewer patients with Killip III and IV in group A than in group B (1.2% vs. 12.8%, P < 0.05). The incidence of in-hospital MACE was also significantly less in group A than in group B (0 vs. 7.7%, P < 0.001). As expected, there were more patients with TIMI 3 flow (95.1% vs. 79.5%, P < 0.05) and fewer TIMI 2 (4.9% vs. 20.5%, P < 0.05) flow post PCI in group A than in group B and all 3 patients with MACE were group B patients with TIMI 2 flow. CONCLUSION: Early ST resolution post PCI represents improved myocardial perfusion and function and is related to a favorable clinical outcome in STEMI patients.