接受直接冠状动脉介入治疗的急性心肌梗死患者中梗死区域对经酶学估测梗死面积校正后左室射血分数的影响

作     者：Elsman P. van't Hof A.W.J. de Boer M.-J. 罗亮 

作者机构：Department of Cardiology Isala Klinieken location Weezenlanden Zwolle Netherlands Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第11期

页      面：17-18页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：后左室 梗死面积 梗死区域 急性心肌梗死 射血分数 介入治疗 左室功能 酶学 乳酸脱氢酶 释放量 

摘      要：Background: Left ventricular function and infarct size are strong predictors for prognosis after acute myocardial infarction(MI). Anterior MI is associated with greater reduction of left ventricular ejection fraction(LVEF) and worse prognosis. Our objective was to study whether the impact of infarct size on global LVEF is dependent of infarct location. Methods: We analyzed 888 patients treated with primary percutaneous coronary intervention for acute MI. Enzymatic infarct size and LVEF within 1 week were measured. In 490 patients(55%), LVEF was measured a second time at 6 months. Results: Every 1000 U/L of cumulative lactate dehydrogense release corresponded to a decrease of 4.7%(95%CI 4.1-5.3) in LVEF measured within 1 week post MI for left anterior descending coronary artery(LAD)related infarcts and to a decrease of 2.4%(95%CI 1.7-3.1) in LVEF measured within 1 week post MI for non-LAD-related infarcts(P .0001). Left ventricular ejection fraction measured 6 months post MI showed a decrease for every 1000 U/L cumulative lactate dehydrogense release of 4.8%(95%CI 4.2-5.3) for LAD and 2.4%(95%CI 1.7-3.1) for non-LAD-related infarcts(P .0001). Multivariate correction for relevant clinical and angiographic data did not change these results. Conclusion: In patients with a first acute MI treated with primary percutaneous coronary intervention, LAD-related infarcts show for a similar amount of myocardial necrosis as determined by enzymatic infarct size, a lower residual LVEF when compared with non-LAD-related infarcts.