García Barsotti María A, Corbalán Herreros Ramón, Nazzal Nazal Carolina, Marchant Díaz Eugenio, Castro Gálvez Pablo, Pérez Pérez Osvaldo, Larraín González Germán
Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Esp Cardiol. 2004 Jun;57(6):524-30.
The aim of this study was to compare the prognostic value of TIMI 3 flow versus noninvasive markers of coronary artery reperfusion on the outcome of patients with a recent acute myocardial infarction (AMI) treated with primary angioplasty. PATIENTS AND METHOD We analyzed 172 consecutive patients with AMI and ST-segment elevation, who were treated with primary angioplasty within 12 hours of admission. Mean age was 6113 years, 77% were men, and 56% had a history of previous AMI.
In-hospital mortality was 3.6%; 16.6% developed heart failure, and 11.1% had complex arrhythmias during their hospital stay. The noninvasive criterion for successful reperfusion was the presence of two or more markers of reperfusion based on ECG changes or CK levels after angioplasty. Reperfusion was successful in 87.7% of the patients, and TIMI 3 flow was achieved in 87%. There was no significant concordance between the two methods (kappa index = 0.012). Multivariate analysis showed that both successful reperfusion (OR=0.028; 95% CI, 0.003-0.268) and TIMI 3 flow (OR=0.104; 95% CI, 0.019-0.563) were protective for in-hospital mortality. However, in the multivariate analysis only successful reperfusion was a protective factor for heart failure and complex arrhythmias.
Our findings confirm that both TIMI 3 flow and successful coronary reperfusion evaluated noninvasively show independent prognostic value in patients with AMI treated with primary angioplasty. Noninvasive markers of coronary reperfusion should be used as complementary to angiography in these patients.
本研究旨在比较TIMI 3级血流与冠状动脉再灌注的无创标志物对近期接受直接血管成形术治疗的急性心肌梗死（AMI）患者预后的价值。患者与方法：我们分析了172例连续的AMI且ST段抬高患者，他们在入院12小时内接受了直接血管成形术。平均年龄为61±13岁，77%为男性，56%有既往AMI病史。
住院死亡率为3.6%；16.6%发生心力衰竭，11.1%在住院期间发生复杂性心律失常。成功再灌注的无创标准是血管成形术后基于心电图变化或肌酸激酶水平存在两个或更多再灌注标志物。87.7%的患者再灌注成功，87%达到TIMI 3级血流。两种方法之间无显著一致性（kappa指数 = 0.012）。多变量分析显示，成功再灌注（OR = 0.028；95%CI，0.003 - 0.268）和TIMI 3级血流（OR = 0.104；95%CI，0.019 - 0.563）对住院死亡率均有保护作用。然而，在多变量分析中，只有成功再灌注是心力衰竭和复杂性心律失常的保护因素。
我们的研究结果证实，TIMI 3级血流和通过无创评估的冠状动脉成功再灌注在接受直接血管成形术治疗的AMI患者中均显示出独立的预后价值。在这些患者中，冠状动脉再灌注的无创标志物应作为血管造影的补充手段使用。
