Gibson C Michael, de Lemos James A, Murphy Sabina A, Marble Susan J, Dauterman Kent W, Michaels Andrew, Barron Hal V, Antman Elliott M
Department of Medicine, Brigham & Women's Hospital, USA.
J Thromb Thrombolysis. 2002 Dec;14(3):233-7. doi: 10.1023/a:1025004911375.
Improved microvascular perfusion using the TIMI myocardial perfusion grade (TMPG) has been related to reduced in hospital, 30-day and 2-year mortality following thrombolytic administration. We sought to validate this measure using the more quantitative technique of digital subtraction angiography (DSA) and to correlate TMPG with ST segment resolution. DSA was used to analyze films from the LIMIT AMI acute myocardial infarction trial of front loaded r-tPA and rhuMAb CD18. Dye kinetics were also characterized using DSA in 88 arteries from patients without acute coronary syndromes in the absence of an obstructive lesion. Compared to normal patients, microvascular perfusion was reduced in acute myocardial infarction patients on DSA as demonstrated by a reduction in peak Gray (brightness) (p < 0.0001), the rate of rise in Gray/sec (p < 0.0001), the blush circumference (p < 0.0001), and the rate of growth in circumference (cm/sec) (p < 0.0001). However, while DSA perfusion was impaired overall in the setting of acute myocardial infarction, TMPG grade 3 in the setting of acute myocardial infarction did not differ from that in normal patients when studied quantitatively as shown by similar rates of growth in brightness and circumference (p = NS). ST resolution and the TMPG were significantly associated (p = 0.04). Compared to normal patients, acute myocardial infarction reduces the peak brightness of the myocardium, the rate of rise in brightness, the circumference of blush and the rate of growth in circumference as assessed using digital subtraction angiography. However, acute myocardial infarction patients with TMPG 3 had rates of growth in brightness and circumference that were nearly identical to normal patients. Thus, DSA validates that TMPG 3 is associated with normal kinetics of myocardial perfusion, and this likely accounts for the low (0.7%) 30 day mortality observed among those patients with TFG 3 and TMPG 3.
使用心肌梗死溶栓治疗（TIMI）心肌灌注分级（TMPG）改善微血管灌注与溶栓治疗后住院期间、30天及2年死亡率降低相关。我们试图使用更定量的数字减影血管造影（DSA）技术来验证这一指标，并将TMPG与ST段分辨率相关联。DSA用于分析来自LIMIT AMI急性心肌梗死试验中负荷剂量重组组织型纤溶酶原激活剂（r-tPA）和重组人单克隆抗体CD18的数据。在无阻塞性病变的非急性冠状动脉综合征患者的88条动脉中，也使用DSA对染料动力学进行了表征。与正常患者相比，急性心肌梗死患者的微血管灌注在DSA上表现为峰值灰度（亮度）降低（p < 0.0001）、灰度/秒上升速率降低（p < 0.0001）、造影剂充盈范围降低（p < 0.0001）以及充盈范围生长速率（厘米/秒）降低（p < 0.0001）。然而，虽然在急性心肌梗死情况下DSA灌注总体受损，但当进行定量研究时，急性心肌梗死情况下的TMPG 3级与正常患者并无差异，表现为亮度和充盈范围的生长速率相似（p = 无显著性差异）。ST段分辨率与TMPG显著相关（p = 0.04）。与正常患者相比，急性心肌梗死会降低心肌的峰值亮度、亮度上升速率、造影剂充盈范围及充盈范围生长速率，这是通过数字减影血管造影评估得出的。然而，TMPG 3级的急性心肌梗死患者的亮度和充盈范围生长速率与正常患者几乎相同。因此，DSA证实TMPG 3级与心肌灌注的正常动力学相关，这可能是TMPG 3级和TFG 3级患者30天死亡率低（0.7%）的原因。
