Dobrzycki S, Kozuch M, Kamiński K, Korecki J, Ostasz A, Podgrudna E, Bonda T, Musiał W J
Department of Invasive Cardiology, Medical University of Bialystok, ul. Sklodowskiej 24a, 15-276 Bialystok, Poland.
Rocz Akad Med Bialymst. 2003;48:118-22.
Despite successful restoration of blood flow in epicardial artery after myocardial infarction (MI), some patients do not benefit sufficiently from modern revascularisation methods due to the impairment of microcirculation, also called no-reflow phenomenon. Hyperlipidaemia is well established risk factor of coronary heart disease and its detrimental actions on vessels are widely acknowledged. We attempted to investigate possible relations between hyperlipidaemia and electrocardiographic signs of no-reflow in myocardial infarction after successful primary angioplasty.
A total of 150 consecutive patients with acute myocardial infarction (AMI) with ST elevation who underwent successful primary angioplasty were studied. ECG was obtained directly before and 30 minutes after successful reperfusion. ST segment deviation was measured. Lack of 50% reduction of ST-segment elevation in the lead with maximal initial elevation, 30 minutes after angioplasty was defined as ECG sign of no-reflow.
ST-segment resolution occurred in 116 patients (77%), whereas 34 presented ECG signs of no-reflow (23%). Patients with persistent ST-segment elevation had higher blood LDL and total cholesterol (TC) levels than group with ST-segment restoration (146.5 vs. 128.7 p < 0.01 and 219.5 vs. 200.9, p < 0.05 respectively). Triglyceride, HDL, glucose on admission and fasting glucose levels did not differ significantly between groups. ECG signs of no-reflow were observed more often in patients with anterior AMI, history of prior myocardial infarction and longer pain-to-balloon time (p < 0.05).
Positive relation between impaired tissue perfusion and high TC and LDL blood levels suggests that lipids may play a role in the pathogenesis of no-reflow phenomenon, possibly by impairment of endothelial function.
尽管心肌梗死（MI）后心外膜动脉血流成功恢复，但由于微循环受损（也称为无复流现象），一些患者并未从现代血运重建方法中充分获益。高脂血症是冠心病公认的危险因素，其对血管的有害作用已得到广泛认可。我们试图研究高脂血症与成功的直接经皮冠状动脉腔内血管成形术后心肌梗死无复流心电图征象之间的可能关系。
共研究了150例连续的急性ST段抬高型心肌梗死（AMI）患者，这些患者均成功接受了直接经皮冠状动脉腔内血管成形术。在成功再灌注前及再灌注30分钟后直接记录心电图。测量ST段偏移。血管成形术后30分钟，初始抬高幅度最大的导联中ST段抬高降低不足50%被定义为无复流心电图征象。
116例患者（77%）ST段恢复，而34例出现无复流心电图征象（23%）。ST段持续抬高的患者血液低密度脂蛋白（LDL）和总胆固醇（TC）水平高于ST段恢复组（分别为146.5对128.7，p<0.01；219.5对200.9，p<0.05）。两组患者入院时甘油三酯、高密度脂蛋白、血糖及空腹血糖水平无显著差异。前壁AMI、既往心肌梗死病史及疼痛至球囊扩张时间较长的患者更常出现无复流心电图征象（p<0.05）。
组织灌注受损与高TC和LDL血液水平之间的正相关表明，脂质可能在无复流现象的发病机制中起作用，可能是通过损害内皮功能。
