Sorajja Paul, Gersh Bernard J, Costantini Costantino, McLaughlin Michael G, Zimetbaum Peter, Cox David A, Garcia Eulogio, Tcheng James E, Mehran Roxana, Lansky Alexandra J, Kandzari David E, Grines Cindy L, Stone Gregg W
The Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
Eur Heart J. 2005 Apr;26(7):667-74. doi: 10.1093/eurheartj/ehi167. Epub 2005 Feb 25.
ST-segment recovery (SigmaSTR) and myocardial blush (MB) evaluate different elements of microcirculatory integrity after reperfusion therapy in acute myocardial infarction (AMI). We sought to determine whether the combination of SigmaSTR and MB after primary percutaneous coronary intervention (PCI) in AMI has greater prognostic utility than either measure alone.
The 30 days and 1 year clinical outcomes of 456 patients were assessed as a function of SigmaSTR and MB after primary PCI from the CADILLAC trial. SigmaSTR and MB were concordant (> or =70% SigmaSTR and MB grade 2/3 or <70% SigmaSTR and MB grade 0/1) in 60.1% of patients and discordant in 39.9% of patients. The greatest survival was observed among patients with complete SigmaSTR (> or =70%) and MB grade 2/3 in whom the cumulative rates of death at 30 days and 1 year were 0.6 and 1.2%, respectively. Poorest survival was observed among patients with incomplete SigmaSTR (<70%) and reduced MB (grade 0/1), in whom 30 days and 1 year rates of death were 8.3 and 10.1%, respectively. Intermediate outcomes were present in patients with discordant MB and SigmaSTR. By multivariable analysis, however, SigmaSTR was an independent correlate of survival at 30 days and 1 year (P=0.05 and 0.01, respectively), whereas MB was no longer predictive (P=0.38 and 0.72, respectively).
SigmaSTR and MB are not infrequently discordant after primary PCI. By univariate analysis, both measures of reperfusion success strongly correlate with survival and assessment of both yields incremental prognostic information beyond either measure alone. By multivariable analysis, however, SigmaSTR is the stronger prognostic variable.
ST段恢复（SigmaSTR）和心肌灌注（MB）评估急性心肌梗死（AMI）再灌注治疗后微循环完整性的不同要素。我们试图确定急性心肌梗死患者接受直接经皮冠状动脉介入治疗（PCI）后SigmaSTR和MB联合应用是否比单独使用任一指标具有更大的预后价值。
根据CADILLAC试验，对456例患者直接PCI术后30天和1年的临床结局进行评估，评估指标为SigmaSTR和MB。SigmaSTR和MB一致（SigmaSTR≥70%且MB为2/3级或SigmaSTR＜70%且MB为0/1级）的患者占60.1%，不一致的患者占39.9%。SigmaSTR完全恢复（≥70%）且MB为2/3级的患者生存率最高，30天和1年的累积死亡率分别为0.6%和1.2%。SigmaSTR恢复不完全（＜70%）且MB降低（0/1级）的患者生存率最差，30天和1年的死亡率分别为8.3%和10.1%。MB和SigmaSTR不一致的患者预后居中。然而，通过多变量分析，SigmaSTR是30天和1年生存率的独立相关因素（P分别为0.05和0.01），而MB不再具有预测性（P分别为0.38和0.72）。
直接PCI术后，SigmaSTR和MB常常不一致。单变量分析显示，这两种再灌注成功的指标均与生存率密切相关，二者联合评估比单独使用任一指标可提供更多的预后信息。然而，多变量分析显示，SigmaSTR是更强的预后变量。
