经皮冠状动脉介入治疗术后 TIMI 血流对心原性休克患者的临床意义。

Clinical significance of post-procedural TIMI flow in patients with cardiogenic shock undergoing primary percutaneous coronary intervention.

机构信息

Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27715, USA.

出版信息

JACC Cardiovasc Interv. 2009 Jan;2(1):56-64. doi: 10.1016/j.jcin.2008.10.006.

DOI:10.1016/j.jcin.2008.10.006

PMID:19463399

Abstract

OBJECTIVES

We sought to evaluate the impact of post-primary percutaneous coronary intervention (PCI) Thrombolysis In Myocardial Infarction (TIMI) flow grades in the infarct-related artery (IRA) in patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock.

BACKGROUND

The clinical implications and correlates of post-procedural TIMI flow grades in patients with STEMI and cardiogenic shock treated with primary PCI have not been elucidated.

METHODS

We evaluated 4,731 STEMI patients with cardiogenic shock undergoing primary PCI at 567 hospitals participating in the American College of Cardiology-National Cardiovascular Database CathPCI Registry to determine the association of post-procedural TIMI flow grades 0 to 2 with in-hospital outcomes.

RESULTS

Post-PCI TIMI flow grades 0 to 2 in the IRA were present in 14.7% of patients. Compared with patients with TIMI flow grade 3, those with TIMI flow grades 0 to 2 were more likely to undergo coronary artery bypass graft surgery after PCI (20% vs. 5.4%), and develop renal failure (10.1% vs. 5.1%), cardiac tamponade (1.0% vs. 0.5%), and bleeding requiring blood transfusion (35.2% vs. 21.6%). Unadjusted mortality was more than 2-fold higher with TIMI flow grades 0 to 2 versus TIMI flow grade 3 (63% vs. 27%). There was a graded inverse relationship with TIMI flow in the IRA and the adjusted mortality (odds ratio [OR] for TIMI flow grades 0/1: 5.47 [95% confidence interval (CI): 4.13 to 7.24] and for TIMI flow grade 2: 2.63 [95% CI: 2.02 to 3.42] compared with TIMI flow grade 3). Our study also identified factors associated with post-PCI TIMI flow grades 0 to 2.

CONCLUSIONS

Lack of procedural success (post-PCI TIMI flow grades 0 to 2 in the IRA) after primary PCI for STEMI among patients with cardiogenic shock is associated with a much higher risk of mortality compared with the risk for patients with normal post-PCI TIMI flow grade 3.

摘要

目的

我们旨在评估 ST 段抬高型心肌梗死（STEMI）伴心原性休克患者经皮冠状动脉介入治疗（PCI）后血栓溶栓治疗心肌梗死（TIMI）血流分级在梗死相关动脉（IRA）中的影响。

背景

STEMI 伴心原性休克患者行直接 PCI 后，其 TIMI 血流分级与临床结局的相关性尚未明确。

方法

我们评估了 567 家医院参与美国心脏病学院-国家心血管数据库 CathPCI 注册中心的 4731 例 STEMI 伴心原性休克患者，以确定 IRA 经皮 PCI 后 TIMI 血流分级 0-2 级与住院期间结局的关系。

结果

IRA 经皮 PCI 后 TIMI 血流分级 0-2 级患者占 14.7%。与 TIMI 血流分级 3 级患者相比，TIMI 血流分级 0-2 级患者更有可能在 PCI 后行冠状动脉旁路移植术（20% vs. 5.4%），发生肾衰竭（10.1% vs. 5.1%）、心脏压塞（1.0% vs. 0.5%）和需要输血的出血（35.2% vs. 21.6%）。TIMI 血流分级 0-2 级患者的未调整死亡率比 TIMI 血流分级 3 级患者高两倍以上（63% vs. 27%）。IRA 内 TIMI 血流分级与调整后的死亡率呈梯度负相关（TIMI 血流分级 0/1 级的比值比[OR]：5.47[95%置信区间（CI）：4.13 至 7.24]，TIMI 血流分级 2 级的 OR：2.63[95%CI：2.02 至 3.42]，与 TIMI 血流分级 3 级相比）。我们的研究还确定了与 PCI 后 TIMI 血流分级 0-2 级相关的因素。