Cura Fernando, Albertal Mariano, Thierer Jorge, Escudero Alejandro Garcia, Candiello Alfonsina, Jozami Samir, Baliño Pablo Perez, Padilla Lucio T, Trivi Marcelo, Belardi Jorge A
Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
Coron Artery Dis. 2011 Mar;22(1):92-5. doi: 10.1097/MCA.0b013e32834235ef.
The relationship of the ischemic time to primary angioplasty and the quality of myocardial reperfusion according to infarcted territory among patients with ST-segment elevation myocardial infarction (STEMI) is unclear.
This study consisted of 140 patients with STEMI within 12 h from the symptom onset and undergoing a primary angioplasty from the Protection of Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation Myocardial Infarction Trial. ST-segment resolution (STR) at 60 min was analyzed by an independent corelab using continuous ST monitoring. Patients were divided according to anterior (n=74) and nonanterior (n=64) locations and according to ischemic time in quartiles (<90, 90-148, 148-241, and 241-635 min).
Although there was no significant decrement in the extent of STR with the ischemic time in the entire population (74, 51, 72, and 51%, respectively, P=not significant), patients with anterior location have a significant reduction in the extent of STR after 90 min compared with those coming after 90 min (70.6 vs. 29.2% of complete STR, P=0.003, respectively).
Patients with anterior STEMI seem to have a stronger impact of ischemic time on the quality of myocardial reperfusion compared with patients with nonanterior location.
ST段抬高型心肌梗死（STEMI）患者中，缺血时间与直接经皮冠状动脉腔内血管成形术以及根据梗死区域划分的心肌再灌注质量之间的关系尚不清楚。
本研究纳入了140例症状发作12小时内、来自急性ST段抬高型心肌梗死高危患者远端栓塞保护试验且接受直接经皮冠状动脉腔内血管成形术的STEMI患者。由独立的核心实验室通过连续ST段监测分析60分钟时的ST段回落（STR）情况。患者根据梗死部位分为前壁组（n = 74）和非前壁组（n = 64），并根据缺血时间分为四分位数组（<90、90 - 148、148 - 241和241 - 635分钟）。
虽然总体人群中STR程度并未随缺血时间显著降低（分别为74%、51%、72%和51%，P无统计学意义），但与缺血时间90分钟后就诊的患者相比，前壁梗死患者在90分钟后STR程度显著降低（完全STR分别为70.6%对29.2%，P = 0.003）。
与非前壁梗死患者相比，前壁STEMI患者的缺血时间对心肌再灌注质量的影响似乎更大。
