Ilia Reuben, Amit Guy, Cafri Carlos, Gilutz Harel, Abu-Ful Akram, Weinstein Jean Marc, Yaroslavtsev Sergey, Gueron Moche, Zahger Doron
Department of Cardiology, Soroka Medical Center, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva 84101, Israel.
Coron Artery Dis. 2003 Sep;14(6):439-41. doi: 10.1097/00019501-200309000-00004.
Despite early recanalization of an occluded infarct-related artery, myocardial reperfusion may remain impaired due to microvascular injury. Reperfusion arrhythmias may indicate successful microvascular reperfusion.
Microvascular reperfusion was assessed prospectively in 42 consecutive patients with ST-segment elevation acute myocardial infarction (AMI) by evaluation of the resolution of ST-segment elevation (<50% of initial level) immediately after successful coronary angioplasty. Patients were divided into two groups: those with ST resolution (n=24) and those without ST resolution (n=18). The presence of reperfusion arrhythmias immediately after recanalization was recorded.
Patients with ST resolution were younger (54+/-12 years compared with 64+/-17 years, P=0.04), their pain-to-recanalization time was shorter (195+/-87 min compared with 294+/-179 min, P=0.05), they were less often diabetic (13% compared with 24%, P=0.05) and were more often given IIb/IIIa inhibitors (58% compared with 22%, P=0.02). Reperfusion arrhythmias were observed in 15 out of 24 patients with ST resolution (62%) but in only one out of 18 without ST resolution (5%) (P<0.01). Reperfusion arrhythmias included accelerated idioventricular rhythm, 13 (81%); multifocal ventricular premature beats, two (13%); and ventricular tachycardia, one (6%). The sensitivity and specificity of reperfusion arrhythmias for ST resolution were 62 and 95%, respectively. In a logistic regression model including age, time to treatment, diabetes, use of IIb/IIIa inhibitors and reperfusion arrhythmias, only the latter was found to be an independent predictor of ST resolution (P<0.01).
Reperfusion arrhythmias following coronary angioplasty for AMI are a highly specific marker for ST resolution and may indicate successful microvascular reperfusion.
尽管梗死相关动脉闭塞后早期再通，但由于微血管损伤，心肌再灌注可能仍会受损。再灌注心律失常可能提示微血管再灌注成功。
通过评估成功冠状动脉血管成形术后ST段抬高的消退情况（初始水平的<50%），对42例连续的ST段抬高型急性心肌梗死（AMI）患者进行微血管再灌注的前瞻性评估。患者分为两组：ST段消退组（n = 24）和ST段未消退组（n = 18）。记录再通后立即出现的再灌注心律失常情况。
ST段消退组患者更年轻（54±12岁，而未消退组为64±17岁，P = 0.04），其疼痛至再通时间更短（195±87分钟，而未消退组为294±179分钟，P = 0.05），糖尿病患者较少（13%，而未消退组为24%，P = 0.05），且更常使用IIb/IIIa抑制剂（58%，而未消退组为22%，P = 0.02）。24例ST段消退患者中有15例（62%）出现再灌注心律失常，而18例未消退患者中仅有1例（5%）出现（P<0.01）。再灌注心律失常包括加速性室性自主心律，13例（81%）；多源性室性早搏，2例（13%）；室性心动过速，1例（6%）。再灌注心律失常对ST段消退的敏感性和特异性分别为62%和95%。在一个包括年龄、治疗时间、糖尿病、IIb/IIIa抑制剂使用情况和再灌注心律失常的逻辑回归模型中，仅发现后者是ST段消退的独立预测因素（P<0.01）。
AMI冠状动脉血管成形术后的再灌注心律失常是ST段消退的高度特异性标志物，可能提示微血管再灌注成功。
