Department of Cardiology, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany.
EuroIntervention. 2011 Feb;6(7):854-9. doi: 10.4244/EIJV6I7A146.
To define frequency and predictors of aborted myocardial infarctions (MI) after primary angioplasty.
We analysed 196 consecutive patients with the clinical diagnosis of ST-elevation acute coronary syndrome (ST-ACS) admitted for primary angioplasty to one interventional facility between October 2005 and September 2006. Aborted MI was defined as a creatine increase of less than two times the upper limit of normal, combined with typical evolutionary electrocardiographic changes. Masquerading MI was diagnosed if evolutionary changes were missing or could be attributed to other causes. Thirty-four patients (17,3%) had an aborted and nine (4,6%) a masquerading MI. The main predictor of abortion was Thrombolysis In Myocardial Infarction (TIMI) flow 2 or 3 prior to procedure. The in-hospital mortality of aborted MI was 0%, the one year mortality 2.9%. Sixteen patients without prior or inter-current myocardial infarction had a preserved ejection fraction on cardiac MR at 12 months; in six patients even without any detection of late enhancement.
There is a substantial proportion of aborted myocardial infarction after primary angioplasty, corresponding to a small or even non detectable scar formation in terms of late enhancement on cardiac MR. Preprocedural TIMI flow 2 or 3 is the main predictor of aborted MI.
确定直接经皮冠状动脉介入治疗（PCI）后，心肌梗死（MI）的再发频率及其预测因素。
我们分析了 2005 年 10 月至 2006 年 9 月期间在一家介入治疗中心因 ST 段抬高型急性冠状动脉综合征（ST-ACS）接受直接 PCI 的 196 例连续患者的临床诊断。再发心肌梗死定义为肌酸激酶升高小于正常上限的两倍，同时伴有典型的心电图演变改变。如果演变变化缺失或归因于其他原因，则诊断为伪装性心肌梗死。34 例（17.3%）患者发生再发心肌梗死，9 例（4.6%）患者发生伪装性心肌梗死。再发的主要预测因素是介入前 TIMI 血流 2 或 3。再发心肌梗死的院内死亡率为 0%，1 年死亡率为 2.9%。16 例无既往或并发心肌梗死的患者在 12 个月时心脏磁共振显示射血分数保留；在 6 例患者中，甚至没有检测到晚期强化。
直接 PCI 后存在相当比例的再发心肌梗死，这与心脏磁共振晚期强化检测到的小或甚至不可检测的瘢痕形成相对应。介入前 TIMI 血流 2 或 3 是再发心肌梗死的主要预测因素。
