Adel Walaa, Nammas Wail
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Int J Angiol. 2010 Summer;19(2):e78-82. doi: 10.1055/s-0031-1278373.
Identification of viable myocardium after myocardial infarction has gained paramount importance with the current progress in coronary revascularization.
To explore the prognostic power of certain patient characteristics to predict myocardial contractile recovery after revascularization in patients presenting with acute anterior ST elevation myocardial infarction (STEMI) who received thrombolytic therapy.
Seventy-three consecutive patients presenting with first acute anterior STEMI who had received thrombolytic therapy and had significant coronary stenosis or occlusion of the infarct-related artery amenable for revascularization were enrolled. 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 two to three months following revascularization. Patients were classified into two groups: group 1 had evidence of contractile recovery after revascularization at follow-up echocardiography and group 2 had no such evidence of recovery.
Predictors of contractile recovery after revascularization included a shorter time from symptom onset to the institution of thrombolytic therapy, a lower baseline wall motion score index, the presence of grade 3 collaterals to the infarct-related artery and the use of beta-blockers. Instead, the presence of diabetes mellitus and a totally occluded infarct-related artery predicted poor contractile recovery.
Myocardial contractile recovery after revascularization in patients presenting with first acute anterior STEMI may be predicted by the absence of diabetes, a shorter time from symptom onset to thrombolytic therapy, the use of beta-blockers, a lower initial wall motion index score and the presence of collaterals to the infarct-related artery.
随着冠状动脉血运重建技术的不断进步，心肌梗死后存活心肌的识别变得至关重要。
探讨在接受溶栓治疗的急性前壁ST段抬高型心肌梗死（STEMI）患者中，某些患者特征对预测血运重建后心肌收缩恢复的预后价值。
连续纳入73例首次发生急性前壁STEMI且接受溶栓治疗、梗死相关动脉存在严重冠状动脉狭窄或闭塞且适合血运重建的患者。所有患者均接受了超声心动图评估局部室壁运动及左心室射血分数。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。血运重建后2至3个月重复超声心动图检查。患者分为两组：第1组在随访超声心动图检查时显示血运重建后有收缩恢复的证据，第2组无此类恢复证据。
血运重建后收缩恢复的预测因素包括症状发作至开始溶栓治疗的时间较短、基线室壁运动评分指数较低、梗死相关动脉存在3级侧支循环以及使用β受体阻滞剂。相反，糖尿病的存在以及梗死相关动脉完全闭塞预示着收缩恢复较差。
首次发生急性前壁STEMI患者血运重建后的心肌收缩恢复可通过无糖尿病、症状发作至溶栓治疗的时间较短、使用β受体阻滞剂、初始室壁运动指数评分较低以及梗死相关动脉存在侧支循环来预测。
