Araszkiewicz Aleksander, Lesiak Maciej, Grajek Stefan, Cieśliński Andrzej
1st Department of Cardiology, Medical Academy, Poznań, Poland.
Kardiol Pol. 2004 May;60(5):447-53.
Modern therapy of acute myocardial infarction (AMI) is aimed at rapid and persisting restoration of blood flow in an infarct-related artery (IRA). However, in some patients myocardial reperfusion is not achieved in spite of effective IRA recanalisation. Myocardial Blush Grade (MBG) is one of the angiographic markers useful for the detection of this phenomenon.
To assess the prognostic value of MBG in patients with anterior AMI treated with primary angioplasty.
The study group consisted of 104 patients (74 males, 30 females, mean age 62+/-13 years) treated with primary angioplasty due to anterior ST-segment elevation AMI. MBG was assessed after the procedure. The mortality and major cardiovascular event (MACE) rates were analysed one and six months after AMI.
Patients with preserved myocardial reperfusion following angioplasty (MBG 2-3, n=64 (61.5%)) had a trend towards lower one-month mortality and significantly reduced six-month mortality compared with 40 (38.5%) patients with an impaired (MBG 0-1) myocardial reperfusion (3% vs 12.5%, NS; and 6.25% vs 20%, p<0.05, respectively). The rate of MACE was significantly lower in patients with rather than without reperfusion both after one and six months of follow-up (9.4% vs 27.5%, p=0.027 and 12.5% vs 42.5%, p<0.001, respectively). Compared with patients with a high MBG score, patients with altered reperfusion more frequently had diabetes (30% vs 12.5%, p=0.04), hypertension (67.5% vs 45%, p=0.043), longer time from the onset of symptoms to balloon inflation (355.9+/-199 min vs 215.5+/-113 min, p<0.001) and lower left ventricular ejection fraction, measured 3 days after AMI (43.3%+/-8 vs 47.4%+/-9, p=0.02).
MBG has a significant prognostic value in patients with anterior AMI treated with primary angioplasty. Diabetes, hypertension and long delay of treatment are associated with the impairment of myocardial reperfusion.
急性心肌梗死（AMI）的现代治疗旨在使梗死相关动脉（IRA）迅速且持续地恢复血流。然而，尽管IRA成功再通，但部分患者仍未实现心肌再灌注。心肌 blush 分级（MBG）是用于检测此现象的血管造影标记物之一。
评估MBG在接受直接经皮冠状动脉腔内血管成形术（primary angioplasty）治疗的前壁AMI患者中的预后价值。
研究组由104例因前壁ST段抬高型AMI接受直接经皮冠状动脉腔内血管成形术治疗的患者组成（74例男性，30例女性，平均年龄62±13岁）。术后评估MBG。分析AMI后1个月和6个月时的死亡率及主要心血管事件（MACE）发生率。
血管成形术后心肌再灌注良好（MBG 2 - 3级，n = 64例（61.5%））的患者1个月死亡率有降低趋势，6个月死亡率显著降低，相比40例（38.5%）心肌再灌注受损（MBG 0 - 1级）的患者（分别为3%对12.5%，无统计学差异；6.25%对20%，p < 0.05）。随访1个月和6个月时，有再灌注的患者MACE发生率均显著低于无再灌注的患者（分别为9.4%对27.5%，p = 0.027；12.5%对42.5%，p < 0.001）。与MBG评分高的患者相比，再灌注改变的患者更常患有糖尿病（30%对12.5%，p = 0.04）、高血压（67.5%对45%，p = 0.043）、症状发作至球囊扩张的时间更长（355.9±199分钟对215.5±113分钟，p < 0.001），且AMI后3天测量的左心室射血分数更低（43.3%±8对47.4%±9，p = 0.02）。
MBG在接受直接经皮冠状动脉腔内血管成形术治疗的前壁AMI患者中具有显著的预后价值。糖尿病、高血压及治疗延迟与心肌再灌注受损相关。
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