ST 段抬高型心肌梗死患者经皮冠状动脉介入治疗延迟对心肌挽救、梗死面积和微血管损伤的影响：心血管磁共振的观察。
Impact of primary coronary angioplasty delay on myocardial salvage, infarct size, and microvascular damage in patients with ST-segment elevation myocardial infarction: insight from cardiovascular magnetic resonance.
机构信息
Cardiovascular Magnetic Resonance Unit, Department of Radiology Sciences, Sapienza University of Rome, Rome 00161, Italy.
出版信息
J Am Coll Cardiol. 2009 Dec 1;54(23):2145-53. doi: 10.1016/j.jacc.2009.08.024.
OBJECTIVES
We investigated the extent and nature of myocardial damage by using cardiovascular magnetic resonance (CMR) in relation to different time-to-reperfusion intervals.
BACKGROUND
Previous studies evaluating the influence of time to reperfusion on infarct size (IS) and myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) have yielded conflicting results.
METHODS
Seventy patients with STEMI successfully treated with primary percutaneous coronary intervention within 12 h from symptom onset underwent CMR 3 +/- 2 days after hospital admission. Patients were subcategorized into 4 time-to-reperfusion (symptom onset to balloon) quartiles: < or =90 min (group I, n = 19), >90 to 150 min (group II, n = 17), >150 to 360 min (group III, n = 17), and >360 min (group IV, n = 17). T2-weighted short tau inversion recovery and late gadolinium enhancement CMR were used to characterize reversible and irreversible myocardial injury (area at risk and IS, respectively); salvaged myocardium was defined as the normalized difference between extent of T2-weighted short tau inversion recovery and late gadolinium enhancement.
RESULTS
Shorter time-to-reperfusion (group I) was associated with smaller IS and microvascular obstruction and larger salvaged myocardium. Mean IS progressively increased overtime: 8% (group I), 11.7% (group II), 12.7% (group III), and 17.9% (group IV), p = 0.017; similarly, MVO was larger in patients reperfused later (0.5%, 1.5%, 3.7%, and 6.6%, respectively, p = 0.047). Accordingly, salvaged myocardium markedly decreased when reperfusion occurred >90 min of coronary occlusion (8.5%, 3.2%, 2.4%, and 2.1%, respectively, p = 0.004).
CONCLUSIONS
In patients with STEMI treated with primary percutaneous coronary intervention, time to reperfusion determines the extent of reversible and irreversible myocardial injury assessed by CMR. In particular, salvaged myocardium is markedly reduced when reperfusion occurs >90 min of coronary occlusion.
目的
通过心血管磁共振（CMR）研究不同再灌注时间间隔与心肌损伤程度和性质的关系。
背景
先前评估 ST 段抬高型心肌梗死（STEMI）患者再灌注时间对梗死面积（IS）和心肌挽救的影响的研究结果相互矛盾。
方法
70 例 STEMI 患者于症状发作后 12 小时内成功接受了直接经皮冠状动脉介入治疗，在入院后 3 天内进行 CMR。患者分为 4 个再灌注时间（症状发作至球囊）四分位数：<或=90 分钟（组 I，n=19），90-150 分钟（组 II，n=17），150-360 分钟（组 III，n=17）和>360 分钟（组 IV，n=17）。T2 加权短反转恢复和晚期钆增强 CMR 用于确定可逆性和不可逆性心肌损伤（危险区和 IS）；挽救的心肌定义为 T2 加权短反转恢复和晚期钆增强之间的归一化差异。
结果
较短的再灌注时间（组 I）与较小的 IS 和微血管阻塞以及较大的挽救性心肌相关。IS 随时间逐渐增加：8%（组 I），11.7%（组 II），12.7%（组 III）和 17.9%（组 IV），p=0.017；同样，在再灌注时间较晚的患者中 MVO 更大（分别为 0.5%、1.5%、3.7%和 6.6%，p=0.047）。因此，当闭塞时间超过 90 分钟时，挽救性心肌明显减少（分别为 8.5%、3.2%、2.4%和 2.1%，p=0.004）。
结论
在接受直接经皮冠状动脉介入治疗的 STEMI 患者中，再灌注时间决定了 CMR 评估的可逆性和不可逆性心肌损伤的程度。特别是，当闭塞时间超过 90 分钟时，挽救性心肌明显减少。
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