急性心肌梗死经皮冠状动脉介入治疗后心肌灌注的方法评价

目的　联合应用TIMI心肌灌注分级 (TMP)、校正的TIMI画面记帧 (CTFC)、心电图ST段变化 (sumSTR)方法评价急性心肌梗死 (AMI)急诊经皮冠状动脉介入治疗 (PCI)后心肌灌注程度 ,探讨心肌灌注程度对临床预后的影响。方法　 77例AMI患者PCI后即刻采用TMP CTFC、TMP sumSTR、CTFC sumSTR三种联合方法评价心肌灌注程度 ,PCI术后 1个月检查双核素心肌灌注显像 ,记录 6个月心脏事件。结果　评价心肌灌注程度 ,与双核素心肌灌注显像对比 ,TMP sumSTR敏感性 86 7%、特异性 85 7%、准确性 86 2 % ;TMP CTFC敏感性 80 %、特异性 77 1%、准确性 78 5 % ;多变量回归分析TMP 0 / 1级 sumSTR <30 %为 6个月心脏事件的独立危险因子 (OR=2 1 5 ,95 %可信区间 2 7～ 6 5 7,P =0 0 0 3) ;Kaplan Meier分析曲线显示TMP sumSTR方法评价的心肌灌注不良组 6个月心脏事件高于心肌灌注良好组 (P <0 0 5 )。结论　TMP sumSTR、TMP CTFC能更好的评价心肌灌注程度 ;TMP sumSTR可预测 6个月心脏事件。

Assessment of myocardial reperfusion in patients with acute myocardial infarction after PCI therapy

Objective To assess the extent of perfusion of acute myocardial infarction (AMI) undergoin g percutaneous coronary intervention (PCI) and to explore the influence of myoca rdial perfusion to prognosis by the combined use of TIMI myocardial perfusion (T MP), corrected TIMI frame count (CTFC) and sum-ST-segment resolution (sumSTR). Methods Immediately after PCI for 77 patients with AMI, myoc ardial reperfusion was assessed by three combinations: TMP plus CTFC, TMP plus s umSTR(30%)and CTFC plus sumSTR. Double nucleic myocardial perfusion imaging ( _99mTc-MIBI/_18FDG DISA SPECT) was performed within 1 month after PCI , and cardiac events within 6 months were recorded. Results Co mpared with DISA SPECT in terms of myocardial perfusion, the sensitivity, specif icity, and accuracy of TMP sumSTR(30%) was 86.7%, 85.7%, and 86.2% respective ly ; for TMP CTFC it was 80.0%, 77.1%, and 78.5% respectively. Multivariate analysis showed that TMP0/1 sumSTR<30% was the independent risk factor for 6 mo nth cardiac events (OR=2.15, 95% CI, 2.7-65.7, P<0.01). Conclusion TMP sumSTR and TMP CTFC may better assess myocardial per fusion. TMP CTFC may predict 6-month cardiac events.