Appelbaum Evan, Abraham JoEllyn M, Pride Yuri B, Harrigan Caitlin J, Peters Dana C, Biller Leah H, Manning Warren J, Gibson C Michael
Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Am Heart J. 2009 Jul;158(1):84-91. doi: 10.1016/j.ahj.2009.04.012.
Primary percutaneous coronary intervention (pPCI) routinely restores normal epicardial flow among patients with ST-segment elevation myocardial infarction (STEMI). However, impairment of myocardial perfusion frequently persists. The goal of this analysis was to determine whether impaired myocardial perfusion was associated with cardiovascular magnetic resonance-defined abnormalities in infarct architecture, including infarct size (IS), infarct surface area (ISA), infarct border zone (IBZ), and infarct complexity (IC).
Thirty-one patients with STEMI treated with pPCI were included in the analysis. Cardiovascular magnetic resonance was performed within 7 days of presentation and repeated at 3 months. Infarct complexity was defined as the ratio of actual ISA to an idealized smooth ISA and normalized to IS.
Impaired Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade (TMPG) (<3) was associated with larger ISA at baseline (78.2 +/- 25.3 cm(2) vs 40.3 +/- 30.3 cm(2), P = .02) and follow-up (58.8 +/- 27.5 cm(2) vs 26.3 +/- 20.2 cm(2), P = .03) and larger IBZ at follow-up (7.8% +/- 2.7% vs 4.1% +/- 3.3%, P = .02). At follow-up, ISA, when normalized to IS, was significantly higher among patients with impaired myocardial perfusion (TMPG <3) (6.9 +/- 2.5 vs 5.9 +/- 2.4 cm(2)/%, P = .03). Thrombolysis in MI myocardial perfusion grade <3 was also associated with increased IC at follow-up (52% +/- 12% vs 33% +/- 16%, P = .01).
Impaired TMPG is associated with larger ISA, IBZ, and increased IC. At 3 months, TMPG remained associated with ISA and IC after adjusting for IS, suggesting that impaired TMPG after pPCI is associated with infarct architecture after healing, independent of IS.
在ST段抬高型心肌梗死（STEMI）患者中，直接经皮冠状动脉介入治疗（pPCI）通常可恢复正常的心外膜血流。然而，心肌灌注受损常常持续存在。本分析的目的是确定心肌灌注受损是否与心血管磁共振定义的梗死灶结构异常相关，包括梗死面积（IS）、梗死表面积（ISA）、梗死边缘区（IBZ）和梗死复杂性（IC）。
31例接受pPCI治疗的STEMI患者纳入分析。在发病7天内进行心血管磁共振检查，并在3个月时重复检查。梗死复杂性定义为实际ISA与理想化平滑ISA的比值，并根据IS进行标准化。
心肌梗死溶栓治疗心肌灌注分级（TMPG）受损（<3）与基线时更大的ISA相关（78.2±25.3 cm²对40.3±30.3 cm²，P = 0.02）以及随访时相关（58.8±27.5 cm²对26.3±20.2 cm²，P = 0.03），且与随访时更大的IBZ相关（7.8%±2.7%对4.1%±3.3%，P = 0.02）。在随访时，当根据IS进行标准化后，心肌灌注受损（TMPG<3）的患者中ISA显著更高（6.9±2.5对5.9±2.4 cm²/%，P = 0.03）。心肌梗死溶栓治疗心肌灌注分级<3也与随访时IC增加相关（52%±12%对33%±16%，P = 0.01）。
TMPG受损与更大的ISA、IBZ以及增加的IC相关。在3个月时，调整IS后TMPG仍与ISA和IC相关，提示pPCI后TMPG受损与愈合后的梗死灶结构相关，独立于IS。
