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心电图ST段消退与急性心肌梗死首次经皮冠状动脉介入后早期和晚期结果的关系

世界核心医学期刊文摘（心脏病学分册） 2005年第6期1卷 39-40页

作者： Brodie B.R. Stuckey T.D. Hansen C. 丁倩 Dr.LeBauer Cardiovasc. Res.Found.M. GreensboroNC United States

ST-segment resolution(STR) is a surrogate end point in reperfusion trials of acute myocardial infarction, but there are few data regarding the optimum methods of measurement, clinical predictors, and correlation with late cardiac mortality. Consecutive patients(n=1,005) who had acute myocardial infarction and2.0 mm]) correlated with in-hospital mortality(4.0%vs 6.7%vs 11.6%, p=0.005), reinfarction(1.4%vs 3.4%vs 6.1%, p=0.01), and late cardiac mortality(17%vs 25%vs 44%, p< 0.0001). Correlation with late mortality was stronger for nonanterior than for anterior infarction. Poor STR was a strong independent predictor of late mortality(hazard ratio 1.63, 95%confidence interval 1.06 to 2.50, p= 0.028), even after adjusting for Thrombolysis In Myocardial Infarction flow. These data support the use of STR as a simple method to stratify patients by risk after primary PCI for acute myocardial infarction and support the use of STR as a surrogate end point in reperfusion trials of acute myocardial infarction.

关键词：急性心肌梗死 ST 心肌梗死溶栓非前壁梗死再梗死危险度分层临床预测再灌注测量方法

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急性心肌梗死患者梗死动脉定位、心外膜血流以及直接经皮血运重建后心肌灌注之间的关系

引用

世界核心医学期刊文摘（心脏病学分册） 2006年第11期2卷 15-16页

作者： Kandzari D.E. Tcheng J.E. Gersh B.J. 罗亮 Department of Medicine Duke University Medical Center Duke Clinical Research Institute Durham NC United States Dr.

Background: The association between infarct artery location, reperfusion success, and clinical outcomes after primary percutaneous coronary intervention(PCI) has not been characterized. We examined the infarct artery-specific impact of epicardial and myocardial flow and reperfusion after primary PCI for acute myocardial infarction. Methods: Among 2082 patients undergoing primary PCI in the CADILLAC trial, myocardial blush grade, TIMI flow grade, ST-segment resolution, and clinical outcomes were analyzed according to the infarct artery. Results: Baseline clinical characteristics did not significantly differ between patients experiencing infarction in the left anterior descending(LAD, 37%) versus left circumflex(18%) and right coronary artery(46%) distributions. Baseline left ventricular function was reduced, and collateral flow was less commonly present in patients with infarction involving the LAD. Achievement of final TIMI-3 flow, grade 3 myocardial blush, and ST-segment resolution >70%was also significantly less common in anterior infarction. Patients with anterior versus nonanterior infarction had significantly higher mortality at 30 days(3.4%vs 1.3%, P=.0006) and 1 year(6.5%vs 2.9%, P< .0001) and had increased 1-year rates of reinfarction(3.6%vs 1.7%, P=.009) and ischemic target vessel revascularization(16.1%vs 11.7%, P=.006). By multivariate analysis, LAD infarction was a powerful independent predictor of 1-year mortality(odds ratio 2.45, P=.009). Conclusions: Acute myocardial infarction involving the LAD distribution is associated with reduced left ventricular function, less frequent collateral flow, impaired myocardial perfusion and decreased reperfusion success, findings associated with reduced survival, and increased major adverse cardiac events compared with other vascular territories. These data provide mechanistic insights to the adverse prognosis of patients with anterior infarction.

关键词：急性心肌梗死心肌灌注血运重建左室功能非前壁梗死左旋支再梗死前降支不良心脏事件年死亡

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