Majidi Mohamed, Kosinski Andrzej S, Al-Khatib Sana M, Lemmert Miguel E, Smolders Lilian, van Weert Anton, Reiber Johan H C, Tzivoni Dan, Bär Frits W H M, Wellens Hein J J, Gorgels Anton P M, Krucoff Mitchell W
eECG Core Laboratory, Duke Clinical Research Institute, 508 Fulton Street, Durham, NC 27705, USA.
Eur Heart J. 2009 Apr;30(7):757-64. doi: 10.1093/eurheartj/ehp005. Epub 2009 Feb 7.
Aims Successful epicardial reperfusion with primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) can paradoxically evoke myocardial reperfusion injury, which may be signalled by temporally associated ventricular arrhythmias (VAs). We correlated reperfusion VA 'bursts' with final infarct size (IS) in patients with restored TIMI 3 flow following PCI for anterior STEMI. Methods and results All 128 anterior STEMI patients with final TIMI 3 flow had continuous 24 h digital 12-lead ECG with simultaneous Holter recording initiated prior to PCI, and Day 7/discharge SPECT imaging IS assessment. Angiography, SPECT imaging, continuous ST recovery, and quantitative rhythm analyses were performed. Reperfusion VA bursts were defined against patient-specific background VA rates and timed as concomitant with or following first angiographic TIMI 3 flow restoration associated with > or =50% stable ST recovery; they were then correlated with IS and global left ventricular ejection fraction (LVEF) at Day 7/discharge. Bursts occurred in 81/128 (63%) patients and were significantly correlated with larger IS and worse LVEF (median: 21.0 vs. 10.0%, P < 0.001; 35.5 vs. 46.5%, P < 0.001, respectively). In multivariable analyses that adjusted for known predictors of IS, the association of bursts with larger IS remained significant; similar results were seen for worse LVEF. Conclusion Reperfusion VA bursts predict larger IS despite TIMI 3 flow restoration with > or =50% stable ST recovery following PCI for anterior STEMI. Well-characterized reperfusion VAs may provide a novel biomarker of reperfusion injury.
目的 对于ST段抬高型心肌梗死（STEMI）患者，通过直接经皮冠状动脉介入治疗（PCI）实现成功的心外膜再灌注可能反常地引发心肌再灌注损伤，这可能由与之在时间上相关的室性心律失常（VA）所预示。我们将前壁STEMI患者PCI术后TIMI血流3级恢复的再灌注VA “发作” 与最终梗死面积（IS）进行了关联分析。方法与结果 所有128例最终TIMI血流3级的前壁STEMI患者在PCI术前均进行了连续24小时的数字化12导联心电图检查及同步动态心电图记录，并在第7天/出院时进行单光子发射计算机断层扫描（SPECT）成像评估IS。进行了血管造影、SPECT成像、连续ST段恢复情况及定量节律分析。再灌注VA发作是根据患者特异性背景VA发生率来定义的，时间确定为与首次血管造影显示TIMI血流3级恢复且ST段稳定恢复≥50%同时或之后；然后将其与第7天/出院时的IS及整体左心室射血分数（LVEF）进行关联分析。81/128（63%）例患者出现发作，且与更大的IS及更差的LVEF显著相关（中位数：分别为21.0% 对10.0%，P < 0.001；35.5% 对46.5%，P < 0.001）。在针对已知的IS预测因素进行校正的多变量分析中，发作与更大的IS之间的关联仍然显著；LVEF更差时也有类似结果。结论 尽管前壁STEMI患者PCI术后TIMI血流3级恢复且ST段稳定恢复≥50%，但再灌注VA发作预示着更大的IS。特征明确的再灌注VA可能提供一种新的再灌注损伤生物标志物。
