急性心肌梗死后梗死相关动脉罪犯病变伴斑块破裂行经皮冠状动脉介入治疗无复流的预测因素。

Predictors of no-reflow after percutaneous coronary intervention for culprit lesion with plaque rupture in infarct-related artery in patients with acute myocardial infarction.

机构信息

Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Republic of Korea.

出版信息

J Cardiol. 2009 Aug;54(1):36-44. doi: 10.1016/j.jjcc.2009.03.003. Epub 2009 Apr 19.

DOI:10.1016/j.jjcc.2009.03.003

PMID:19632518

Abstract

BACKGROUND

We investigated the predictors of the no-reflow phenomenon after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients with plaque rupture (PR).

METHODS

The study group comprised 112 AMI patients who underwent pre- and post-PCI intravascular ultrasound (IVUS) and stent implantation. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after PCI. IVUS findings included multiple ruptured plaques (PRs separated by a >5-mm length of artery containing smooth lumen contours), thrombus (had a layered lobulated appearance, evidence of blood flow within the mass, and speckling or scintillation), and plaque prolapse (tissue extrusion through the stent struts).

RESULTS

Of 112 patients, no-reflow was observed in 17 patients (15.2%). High-sensitivity C-reactive protein (hs-CRP) was significantly higher (6.2+/-6.0 mg/dl vs. 2.2+/-2.9 mg/dl, p=0.002) and baseline TIMI flow grade was significantly lower in no-reflow group (TIMI flow grade<3: 59% vs. 18%, p<0.001). Lesion site plaque plus media area was significantly greater (12.9+/-2.6 mm(2) vs. 10.8+/-4.2 mm(2), p=0.009), remodeling index was significantly higher (1.14+/-0.17 vs. 1.03+/-0.20, p=0.031), and the presence of IVUS-detected thrombus (88% vs. 56%, p=0.012), culprit lesion multiple PRs (71% vs. 37%, p=0.009), and plaque prolapse (65% vs. 34%, p=0.015) were significantly more common in no-reflow group. In the multivariate analysis, plaque prolapse (OR=33.02; 95% CI 3.38-322.75, p=0.003), hs-CRP (OR=1.03; 95% CI 1.01-1.05, p=0.013), and culprit lesion multiple PRs (OR=15.73; 95% CI 1.61-153.46, p=0.018) were independent predictors of post-PCI no-reflow in AMI patients with PR.

CONCLUSIONS

Elevated hs-CRP and IVUS-detected multiple PRs and plaque prolapse are associated with no-reflow after PCI for PR-containing culprit lesion in infarct-related arteries in AMI patients.

摘要

背景

我们研究了急性心肌梗死（AMI）伴斑块破裂（PR）患者经皮冠状动脉介入治疗（PCI）后无复流现象的预测因素。

方法

研究组包括 112 例 AMI 患者，这些患者在 PCI 前后进行了血管内超声（IVUS）和支架植入。血管造影无复流定义为 PCI 后 TIMI 血流分级 0、1 和 2。IVUS 结果包括多个破裂斑块（PR，由>5mm 长的动脉分隔，动脉内含有光滑管腔轮廓）、血栓（具有分层叶状外观，在肿块内有血流证据，以及斑点或闪烁）和斑块隆起（组织通过支架支柱挤出）。

结果

112 例患者中，17 例（15.2%）出现无复流。高敏 C 反应蛋白（hs-CRP）显著升高（6.2+/-6.0mg/dl 与 2.2+/-2.9mg/dl，p=0.002），无复流组基线 TIMI 血流分级显著降低（TIMI 血流分级<3：59%与 18%，p<0.001）。病变部位斑块加中膜面积明显增大（12.9+/-2.6mm²与 10.8+/-4.2mm²，p=0.009），重塑指数明显升高（1.14+/-0.17 与 1.03+/-0.20，p=0.031），IVUS 检测到血栓（88%与 56%，p=0.012）、罪犯病变多发性 PR（71%与 37%，p=0.009）和斑块隆起（65%与 34%，p=0.015）的发生率明显更高。多变量分析显示，斑块隆起（OR=33.02；95%CI 3.38-322.75，p=0.003）、hs-CRP（OR=1.03；95%CI 1.01-1.05，p=0.013）和罪犯病变多发性 PR（OR=15.73；95%CI 1.61-153.46，p=0.018）是 AMI 患者伴 PR 的梗死相关动脉内 PCI 后无复流的独立预测因素。