急性心肌梗死直接血管成形术后左心室功能的长期恢复

Long-term recovery of left ventricular function after primary angioplasty for acute myocardial infarction.

作者信息

Ottervanger J P, van 't Hof A W, Reiffers S, Hoorntje J C, Suryapranata H, de Boer M J, Zijlstra F

机构信息

Department of Cardiology, Isala Klinieken-Hospital de Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.

出版信息

Eur Heart J. 2001 May;22(9):785-90. doi: 10.1053/euhj.2000.2316.

DOI:10.1053/euhj.2000.2316

PMID:11350111

Abstract

AIMS

To investigate changes in left ventricular function in the first 6 months after acute myocardial infarction treated with primary angioplasty. To assess clinical variables, associated with recovery of left ventricular function after acute myocardial infarction.

METHODS

Changes in left ventricular function were studied in 600 consecutive patients with acute myocardial infarction, all treated with primary angioplasty. Left ventricular ejection fraction was measured by radionuclide ventriculography in survivors at day 4 and after 6 months. Patients with a recurrent myocardial infarction within the 6 months were excluded.

RESULTS

Successful reperfusion (TIMI 3 flow) by primary angioplasty was achieved in 89% of patients. The mean ejection fraction at discharge was 43.7%+/-11.4, whereas the mean ejection fraction after 6 months was 46.3%+/-11.5 (P<0.01). During the 6 months, the mean relative improvement in left ventricular ejection fraction was 6%. An improvement in left ventricular function was observed in 48% of the patients; 25% of the patients had a decrease, whereas in the remaining patients there was no change. After univariate and multivariate analysis, an anterior infarction location, an ejection fraction at discharge < or =40% and single-vessel disease were significant predictors of left ventricular improvement during the 6 months.

CONCLUSIONS

After acute myocardial infarction treated with primary angioplasty there was a significant recovery of left ventricular function during the first 6 months after the infarction. An anterior myocardial infarction, single-vessel coronary artery disease, and an initially depressed left ventricular function were independently associated with recovery of left ventricular function. Multivessel disease was associated with absence of functional recovery. Additional studies, investigating complete revascularization are needed, as this approach may potentially improve long-term left ventricular function.

摘要

目的

研究急性心肌梗死后接受直接血管成形术治疗的前6个月内左心室功能的变化。评估与急性心肌梗死后左心室功能恢复相关的临床变量。

方法

对600例连续的急性心肌梗死患者进行左心室功能变化研究，所有患者均接受直接血管成形术治疗。通过放射性核素心室造影术在第4天和6个月后对存活患者测量左心室射血分数。排除6个月内发生复发性心肌梗死的患者。

结果

89%的患者通过直接血管成形术成功实现再灌注（TIMI 3级血流）。出院时平均射血分数为43.7%±11.4，而6个月后平均射血分数为46.3%±11.5（P<0.01）。在这6个月期间，左心室射血分数的平均相对改善率为6%。48%的患者左心室功能有所改善；25%的患者功能下降，其余患者则无变化。经过单因素和多因素分析，梗死部位在前壁、出院时射血分数≤40%以及单支血管病变是6个月内左心室功能改善的显著预测因素。