Hatada K, Sugiura T, Kamihata H, Nakamura S, Takahashi N, Yuasa F, Iwasaka T
Cardiovascular Division, Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Chest. 2001 Dec;120(6):1959-63. doi: 10.1378/chest.120.6.1959.
To assess the effect of coronary flow to the infarct zone before primary coronary angioplasty on hospital complications in patients with acute myocardial infarction (MI).
Consecutive case series analysis.
Coronary-care unit in a university hospital.
Two hundred sixty-four consecutive patients with ST-elevation acute MIs who had successful primary percutaneous transluminal coronary angioplasty.
Coronary angiography on hospital admission and serial echocardiography.
The status of infarct-related artery flow before primary angioplasty was evaluated on hospital admission. Left ventricular wall motion and pericardial effusions were studied by echocardiography. One hundred ninety patients had total occlusions (Thrombolysis in Myocardial Infarction [TIMI] flow grade, 0 to 1) in the infarct-related artery (group 1), and 74 patients had antegrade flow (TIMI flow grade, 2 to 3) [group 2] before undergoing primary angioplasty procedures. When group 1 was subdivided into two groups (for the presence and absence of collateral flow), the patients with total occlusions and no collateral flow had a higher incidence of left ventricular aneurysmal wall motion (11% vs 1%, respectively; p = 0.03) and pericardial friction rub (15% vs 3%, respectively; p = 0.03) than did those in group 2. Moreover, those patients with total occlusions and no collateral flow had higher incidences of pericardial effusion (34% vs 17%, respectively; p = 0.02; and 34% vs 9%, respectively; p < 0.01) and in-hospital mortality (8% vs 1%, respectively; p = 0.04; and 8% vs 1%, respectively; p = 0.06) than did those patients in the other two groups.
Despite successful primary angioplasty, the absence of antegrade flow in the infarct-related artery and collateral flow to the infarct zone before angioplasty resulted in a higher incidence of in-hospital complications.
评估急性心肌梗死（MI）患者在直接冠状动脉血管成形术前梗死区域冠状动脉血流对医院并发症的影响。
连续病例系列分析。
大学医院的冠心病监护病房。
264例连续的ST段抬高型急性心肌梗死患者，其直接经皮腔内冠状动脉血管成形术成功。
入院时进行冠状动脉造影及系列超声心动图检查。
入院时评估直接血管成形术前梗死相关动脉血流状况。通过超声心动图研究左心室壁运动及心包积液情况。190例患者梗死相关动脉存在完全闭塞（心肌梗死溶栓治疗[TIMI]血流分级为0至1级）（第1组），74例患者在接受直接血管成形术前梗死相关动脉存在前向血流（TIMI血流分级为2至3级）（第2组）。当将第1组再细分为两组（根据有无侧支血流）时，完全闭塞且无侧支血流的患者左心室室壁瘤样运动（分别为11%和1%；p = 0.03）及心包摩擦音（分别为15%和3%；p = 0.03）的发生率高于第2组患者。此外，完全闭塞且无侧支血流的患者心包积液（分别为34%和17%；p = 0.02；以及分别为34%和9%；p < 0.01）及院内死亡率（分别为8%和1%；p = 0.04；以及分别为8%和1%；p = 0.06）的发生率高于其他两组患者。
尽管直接血管成形术成功，但梗死相关动脉无前向血流以及血管成形术前梗死区域无侧支血流会导致院内并发症发生率更高。
