Abdel-Salam Zainab, Nammas Wail
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Cardiovasc Revasc Med. 2010 Jan-Mar;11(1):2-7. doi: 10.1016/j.carrev.2009.01.003.
We sought to explore the prognostic power of certain patient characteristics to predict myocardial contractile recovery after coronary revascularization in patients with prior myocardial infarction.
We enrolled 100 consecutive patients with prior myocardial infarction, significant coronary stenosis/occlusion amenable for revascularization, and regional wall motion abnormality in the distribution of the affected artery. All patients underwent echocardiographic assessment of regional wall motion and left ventricular ejection fraction. Patients underwent coronary revascularization by either percutaneous angioplasty or surgical bypass. Echocardiography was repeated 8 weeks following revascularization. Patients were classified into two groups: Group 1 with evidence of contractile improvement after revascularization at follow-up echocardiography and Group 2 with no such evidence of improvement. The two groups were compared with respect to patients' clinical characteristics and echocardiographic and angiographic data.
Predictors of contractile recovery after revascularization included angina pectoris, the shorter age of infarction at the time of revascularization, a higher baseline left ventricular ejection fraction, a lower baseline wall motion score index, the presence of Grade 2-3 collaterals to the infarct-related artery, and the absence of dyspnea or diabetes mellitus. Stepwise regression analysis identified the presence of Grade 2-3 collaterals to the infarct-related artery and the age of infarction at the time of revascularization as independent predictors of contractile recovery after revascularization.
In patients with prior myocardial infarction, the presence of Grade 2-3 collaterals to the infarct-related artery and the shorter age of infarction at the time of revascularization independently predicted myocardial contractile recovery after coronary revascularization.
我们试图探讨某些患者特征对既往心肌梗死患者冠状动脉血运重建术后心肌收缩恢复的预测能力。
我们连续纳入了100例既往有心肌梗死、存在适合血运重建的严重冠状动脉狭窄/闭塞且梗死相关动脉分布区域有室壁运动异常的患者。所有患者均接受了室壁运动和左心室射血分数的超声心动图评估。患者通过经皮血管成形术或外科搭桥术进行冠状动脉血运重建。血运重建术后8周重复进行超声心动图检查。患者被分为两组：第1组在随访超声心动图检查时有血运重建后收缩功能改善的证据，第2组无此类改善证据。比较两组患者的临床特征、超声心动图和血管造影数据。
血运重建后收缩功能恢复的预测因素包括心绞痛、血运重建时梗死年龄较短、基线左心室射血分数较高、基线室壁运动评分指数较低、梗死相关动脉存在2-3级侧支循环以及无呼吸困难或糖尿病。逐步回归分析确定梗死相关动脉存在2-3级侧支循环和血运重建时的梗死年龄是血运重建后收缩功能恢复的独立预测因素。
在既往有心肌梗死的患者中，梗死相关动脉存在2-3级侧支循环以及血运重建时梗死年龄较短可独立预测冠状动脉血运重建术后的心肌收缩恢复。
