Ruiz-Nodar Juan M, Feliu Eloísa, Sánchez-Quiñones Jessica, Valencia-Martín José, García Milagros, Pineda Javier, Martín Patricia, Mainar Vicente, Bordes Pascual, Heras Santiago, Quintanilla María A, Sogorb Francisco
Departamento de Cardiología, Hospital General Universitario de Alicante, Alicante, España.
Rev Esp Cardiol. 2011 Nov;64(11):965-71. doi: 10.1016/j.recesp.2011.04.014. Epub 2011 Jul 23.
When fibrinolysis fails in patients with ST elevation myocardial infarction, they are referred for a rescue percutaneous coronary intervention (PCI). However, there is still no evidence of how much myocardium potentially at risk we can actually salvage after rescue PCI.
Fifty consecutive patients. Cardiac magnetic resonance was performed within 6 days. Myocardial necrosis was defined by the extent of abnormal late enhancement, myocardium at risk by extent of edema, and the amount of salvaged myocardium by the difference between myocardium at risk and myocardial necrosis. Finally, myocardial salvage index (MSI) resulted from the fraction (area-at-risk minus infarct-size)/area-at-risk.
The mean time elapsed between pain onset and fibrinolitic agent administration was 176 ± 113 min; time lysis-rescue=PCI 209 ± 122 min; time pain onset-PCI = 390 ± 152 min. The area at risk was 37% ± 13% and infarct size 34.5% ± 13%. Salvaged myocardium was 3% ± 4% and MSI 9 ± 8. Salvaged myocardium and MSI were similar between patients with the artery open on arrival at the catheterization lab (Thrombolysis in Myocardial Infarction [TIMI] 3) and those with TIMI flow ≤ 2 (3.3% ± 3.6% and 8.2 ± 6.9 in TIMI 0-2 vs 3.0% ± 3.7% and 10.8 ± 10.9 in TIMI 3; P=.80 and 0.31, respectively). No significant difference was observed between patients who went through rescue PCI within a shorter time and those with longer delay times.
The myocardial salvage after rescue PCI quantified by cardiac magnetic resonance is very small. The long delay times between pain onset and the opening of the infarct-related artery with PCI are most probably the reason for such a minimal effect of rescue PCI.
ST段抬高型心肌梗死患者溶栓失败后，需接受补救性经皮冠状动脉介入治疗（PCI）。然而，目前尚无证据表明补救性PCI术后实际能挽救多少潜在危险心肌。
连续纳入50例患者。于6天内行心脏磁共振成像检查。心肌坏死由延迟强化异常范围定义，危险心肌由水肿范围定义，挽救心肌量由危险心肌与心肌坏死的差值定义。最后，心肌挽救指数（MSI）由（危险面积减去梗死面积）/危险面积得出。
疼痛发作至溶栓药物给药的平均时间为176±113分钟；溶栓至补救性PCI时间为209±122分钟；疼痛发作至PCI时间为390±152分钟。危险面积为37%±13%，梗死面积为34.5%±13%。挽救心肌为3%±4%，MSI为9±8。导管室到达时动脉开通的患者（心肌梗死溶栓治疗[TIMI]3级）与TIMI血流≤2级的患者之间，挽救心肌和MSI相似（TIMI 0 - 2级时为3.3%±3.6%和8.2±6.9，TIMI 3级时为3.0%± 3.7%和10.8±10.9；P分别为0.80和0.31）。在较短时间内接受补救性PCI的患者与延迟时间较长的患者之间未观察到显著差异。
通过心脏磁共振成像量化的补救性PCI术后心肌挽救量非常小。疼痛发作与PCI开通梗死相关动脉之间的长时间延迟很可能是补救性PCI效果甚微的原因。
