梗死后延迟再通动脉的心肌灌注分级与 1 年时的整体和局部左心室功能相关：来自加拿大完全闭塞研究 2 的分析。
Myocardial perfusion grade after late infarct artery recanalization is associated with global and regional left ventricular function at one year: analysis from the Total Occlusion Study of Canada-2.
机构信息
University of Tromsoe, Tromsoe, Norway.
出版信息
Circ Cardiovasc Interv. 2010 Dec;3(6):549-55. doi: 10.1161/CIRCINTERVENTIONS.109.918722. Epub 2010 Nov 9.
BACKGROUND
Whether myocardial perfusion grade (MPG) following late recanalization of infarct-related arteries (IRAs) predicts left ventricular (LV) function recovery beyond the acute phase of myocardial infarction (MI) is unknown.
METHODS AND RESULTS
The Total Occlusion Study of Canada-2 enrolled stable patients with a persistently occluded IRA beyond 24 hours and up to 28 days post-MI. We studied the relationship between the initial MPG and changes in LV function and volume as well as the change in MPG from immediate post-percutaneous coronary intervention (PCI) to 1 year in 139 PCI patients with thrombolysis in myocardial infarction grade 3 epicardial flow post-PCI and with paired values grouped into impaired or good MPG groups (MPG 0/1 or MPG 2/3). MPG 0/1 patients were more likely to have received thrombolytic therapy and to have a left anterior descending IRA. They had lower blood pressure and LV ejection fraction (LVEF) and a higher heart rate and systolic sphericity index at baseline. Changes in the MPG 0/1 and MPG 2/3 groups from baseline to 1 year were LVEF, 3.3±9.0% and 4.8±8.9% (P=0.42); LV end-systolic volume index (LVESVI), -1.1±9.2 and -4.7±12.3 mL/m(2) (P=0.25); LV end-diastolic volume index (LVEDVI), 0.08±19.1 and -2.4±22.2 mL/m(2) (P=0.67); and SDs/chord for infarct zone wall motion index (WMI), 0.38±0.70 and 0.84±1.11 (P=0.01). By covariate-adjusted analysis, post-PCI MPG 0/1 predicted lower WMI (P<0.001), lower LVEF (P<0.001), and higher LVESVI (P<0.01) but not LVEDVI at 1 year. Of the MPG 0/1 patients, 60% were MPG 2 or 3 at 1 year.
CONCLUSIONS
Preserved MPG is present in a high proportion of patients following late PCI of occluded IRAs post-MI. Poor MPG post-PCI frequently improves MPG over 1 year. MPG graded after IRA recanalization undertaken days to weeks post MI is associated with LV recovery, indicating that MPG determined in the subacute post-MI period remains a marker of viability.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00025766.
背景
梗死相关动脉（IRA）晚期再通后心肌灌注分级（MPG）是否能预测心肌梗死（MI）急性期后的左心室（LV）功能恢复尚不清楚。
方法和结果
加拿大-2 完全闭塞研究纳入了 MI 后持续闭塞 IRA 超过 24 小时至 28 天的稳定患者。我们研究了 139 例经皮冠状动脉介入治疗（PCI）后血栓溶解心肌梗死（TIMI）3 级心外膜血流的 IRA 经 PCI 后存在 1 年配对值的患者中初始 MPG 与 LV 功能和容量变化以及即刻 PCI 后至 1 年期间 MPG 从即刻 PCI 到 1 年期间的变化之间的关系，并将其分为受损 MPG 组（MPG 0/1）和良好 MPG 组（MPG 2/3）。MPG 0/1 患者更可能接受溶栓治疗，IRA 为左前降支。他们的基线血压和左心室射血分数（LVEF）较低，心率和收缩期球体指数较高。从基线到 1 年，MPG 0/1 和 MPG 2/3 组的变化为 LVEF，3.3±9.0%和 4.8±8.9%（P=0.42）；LV 收缩末期容积指数（LVESVI），-1.1±9.2 和-4.7±12.3 mL/m2（P=0.25）；LV 舒张末期容积指数（LVEDVI），0.08±19.1 和-2.4±22.2 mL/m2（P=0.67）；梗死区壁运动指数（WMI）的标准差/弦长，0.38±0.70 和 0.84±1.11（P=0.01）。经协变量调整分析，PCI 后 MPG 0/1 预测较低的 WMI（P<0.001）、较低的 LVEF（P<0.001）和较高的 LVESVI（P<0.01），但 1 年后 LVEDVI 没有变化。在 MPG 0/1 患者中，60%在 1 年内 MPG 为 2 或 3。
结论
MI 后 IRA 晚期 PCI 后，有相当比例的患者存在良好的 MPG。PCI 后较差的 MPG 常在 1 年内改善 MPG。MI 后数天至数周 IRA 再通后分级的 MPG 与 LV 恢复相关，表明亚急性期 MI 后确定的 MPG 仍然是存活的标志物。
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