Abraham JoEllyn M, Gibson C Michael, Pena Gonzalo, Sanz Ricardo, AlMahameed Amjad, Murphy Sabina A, Blanco Jesús, Alonso-Briales Juan, Lopez-Mesa Juan, Gimeno Federico, Sánchez Pedro L, Fernández-Avilés Francisco
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
J Thromb Thrombolysis. 2009 Apr;27(3):253-8. doi: 10.1007/s11239-008-0206-1. Epub 2008 Mar 11.
Higher angiographic perfusion score (APS) following percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has been shown to be associated with improved clinical outcomes. The association between APS after STEMI and left ventricular remodeling as assessed by volumetric parameters derived from left ventriculography has not been assessed.
The APS (the arithmetic sum of the TIMI Flow Grade (TFG) and TIMI Myocardial Perfusion grade (TMPG) before and after percutaneous coronary intervention (PCI), range of 0-12) was assessed in 168 patients from the GRACIA-2 trial. Left ventriculograms performed in the 30 degrees right anterior oblique projection were obtained among 148 patients at initial angiography (prior to PCI) and at 6 weeks. The association of APS with markers of left ventricular remodeling at 6-weeks was examined using left ventricular ejection fraction, delta end systolic volume, delta stroke volume and wall motion index.
Full perfusion (APS 10-12), as compared to partial perfusion (APS 4-9) or failed perfusion (APS 0-3), was associated with a greater left ventricular ejection fraction (61.6% +/- 10.0 vs. 56.9% +/- 12.5 vs. 49.8% +/- 16.9, P = 0.015), a decrease in left ventricular end systolic volume indicating favorable remodeling (mean -4.1 cc +/- 17.3 vs. +2.0 cc +/- 17.3 vs. +9.8 cc +/- 16.1, P = 0.015), a greater improvement in left ventricular stroke volume (mean +13.7 cc +/- 17.1 vs. +6.7 cc +/- 15.5 vs. +1.2 cc +/- 13.4, P = 0.009) and a decreased wall motion index (number of chords in the hypokinetic region) (mean 15.1 +/- 16.4 vs. 21.4 +/- 20.5 vs. 32.9 +/- 22.1, P = 0.026) at 6 weeks.
In conclusion, among patients treated with combined reperfusion and revascularization strategies for STEMI, higher APS is associated with more favorable markers of left ventricular remodeling and improved 6-week left ventricular function.
经皮冠状动脉介入治疗（PCI）后，ST段抬高型心肌梗死（STEMI）患者的血管造影灌注评分（APS）较高已被证明与临床预后改善相关。STEMI后APS与通过左心室造影得出的容积参数评估的左心室重构之间的关联尚未得到评估。
在GRACIA - 2试验的168例患者中评估了APS（经皮冠状动脉介入治疗（PCI）前后的TIMI血流分级（TFG）和TIMI心肌灌注分级（TMPG）的算术和，范围为0 - 12）。在148例患者的初始血管造影（PCI前）和6周时获得了在右前斜30度投影下进行的左心室造影。使用左心室射血分数、收缩末期容积变化、每搏输出量变化和室壁运动指数检查APS与6周时左心室重构标志物的关联。
与部分灌注（APS 4 - 9）或灌注失败（APS 0 - 3）相比，完全灌注（APS 10 - 12）与更高的左心室射血分数相关（61.6%±10.0对56.9%±12.5对49.8%±16.9，P = 0.015），左心室收缩末期容积减少表明重构良好（平均-4.1 cc±17.3对+2.0 cc±17.3对+9.8 cc±16.1，P = 0.015），左心室每搏输出量改善更大（平均+13.7 cc±17.1对+6.7 cc±15.5对+1.2 cc±13.4，P = 0.009），并且在6周时室壁运动指数（运动减弱区域的弦数）降低（平均15.1±16.4对21.4±20.5对32.9±22.1，P = 0.026）。
总之，在接受联合再灌注和血运重建策略治疗的STEMI患者中，较高的APS与左心室重构的更有利标志物和6周时左心室功能改善相关。
