Araszkiewicz Aleksander, Grajek Stefan, Lesiak Maciej, Prech Marek, Pyda Małgorzata, Janus Magdalena, Cieslinski Andrzej
The 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
Am J Cardiol. 2006 Sep 15;98(6):725-8. doi: 10.1016/j.amjcard.2006.04.009. Epub 2006 Jul 26.
We assessed the effect of impaired myocardial blush after primary coronary intervention (PCI) on left ventricular remodeling in patients with ST-segment elevation myocardial infarction (STEMI). The study population consisted of 145 patients with first anterior STEMI that was treated successfully (Thrombolysis In Myocardial Infarction grade 3 flow) with PCI. Left ventricular remodeling was defined as an increase of > or =20% in end-diastolic volume based on repeated echocardiographic measurements in patients. The study population was divided into 2 groups according to the presence (myocardial blush grade [MBG] 2 to 3, n = 86) or absence (MBG 0 to 1, n = 59) of myocardial reperfusion. Left ventricular remodeling appeared in 21% of the entire study group. Poor myocardial blush after PCI was associated with an increased rate of remodeling compared with good myocardial reperfusion (32% vs 14%, hazard ratio 2.308, 95% confidence interval [CI] 1.21 to 4.39, p=0.014). Symptoms of heart failure were observed significantly more often in patients with MBG 0 to 1 (35.6% vs 18.6%, p = 0.032) than in patients with MBG 2 to 3. In multivariate analysis, only age (odds ratio 0.96, 95% CI 0.92 to 0.99, p = 0.02) and MBG 0 to 1 (odds ratio 3.15, 95% CI 1.35 to 7.31, p = 0.008) were associated with left ventricular dilation. In conclusion, impaired microvascular reperfusion is associated with left ventricular remodeling and development of congestive heart failure in patients with anterior STEMI that is treated with primary coronary angioplasty.
我们评估了急性ST段抬高型心肌梗死（STEMI）患者在接受直接冠状动脉介入治疗（PCI）后心肌灌注不良对左心室重构的影响。研究对象为145例首次发生前壁STEMI且PCI治疗成功（心肌梗死溶栓试验3级血流）的患者。根据重复超声心动图测量结果，将左心室重构定义为舒张末期容积增加≥20%。根据心肌再灌注情况（心肌灌注分级[MBG]2至3级，n = 86）或无心肌再灌注情况（MBG 0至1级，n = 59），将研究对象分为两组。整个研究组中有21%出现左心室重构。与心肌再灌注良好相比，PCI术后心肌灌注不良与重构发生率增加相关（32%对14%，风险比2.308，95%置信区间[CI]1.21至4.39，p = 0.014）。MBG 0至1级患者出现心力衰竭症状的比例显著高于MBG 2至3级患者（35.6%对18.6%，p = 0.032）。多因素分析显示，只有年龄（优势比0.96，95%CI 0.92至0.99，p = 0.02）和MBG 0至1级（优势比3.15，95%CI 1.35至7.31，p = 0.008）与左心室扩张相关。总之，微血管再灌注受损与接受直接冠状动脉成形术治疗的前壁STEMI患者的左心室重构和充血性心力衰竭的发生相关。
