Mori Masayuki, Sakakura Kenichi, Wada Hiroshi, Ikeda Nahoko, Jinnouchi Hiroyuki, Sugawara Yoshitaka, Kubo Norifumi, Momomura Shin-ichi, Ako Junya
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Amanuma 1-847, Omiya, Saitama, 330-8503, Japan.
Heart Vessels. 2013 Nov;28(6):677-83. doi: 10.1007/s00380-012-0301-2. Epub 2012 Oct 23.
Left ventricular apical aneurysm (LVAA) is a serious complication of acute anterior myocardial infarction (MI). The purpose of our study was to investigate the clinical features of LVAA in the primary PCI era. A total of 161 acute anterior MI patients who had primary PCI and had an echocardiogram on chronic phase were included. The development of LVAA was reviewed on chronic phase. Univariate and multivariate logistic regression analyses were performed to identify the predictors of LVAA. Primary stenting was performed in 160 patients (99.4 %). Procedural success was obtained in all patients with a final TIMI flow grade 3 obtained in 142 patients (88.2 %). LVAA developed in the chronic phase in 29 patients (18.0 %). Multivariate logistic regression analysis revealed that peak CK (500 mU/ml increase; OR 1.24, 95 % CI 1.09-1.41, p = 0.001), heart rate at discharge (5/min increase; OR 1.39, 95 % CI 1.03-1.87, p = 0.03), final TIMI flow grade ≤2 (vs. TIMI 3; OR 6.95, 95 % CI 1.70-28.36, p = 0.01) and final myocardial brush grade (MBG) ≤2 (vs. MBG 3; OR 4.33, 95 % CI 1.06-17.66, p = 0.04) were significantly associated with the development of LVAA. The initial TIMI flow grade or the grade of collateral flow was not associated with LVAA. In conclusion, peak CK, heart rate, and final TIMI flow grade or final MBG ≤2 were significantly associated with the development of LVAA. Achieving a TIMI flow grade 3 by primary PCI may be important for preventing LVAA.
左心室心尖部室壁瘤（LVAA）是急性前壁心肌梗死（MI）的一种严重并发症。我们研究的目的是探讨在直接经皮冠状动脉介入治疗（PCI）时代LVAA的临床特征。总共纳入了161例接受直接PCI且在慢性期进行了超声心动图检查的急性前壁MI患者。回顾了慢性期LVAA的发生情况。进行单因素和多因素逻辑回归分析以确定LVAA的预测因素。160例患者（99.4%）进行了直接支架置入术。所有患者手术成功，142例患者（88.2%）最终达到TIMI血流3级。29例患者（18.0%）在慢性期发生LVAA。多因素逻辑回归分析显示，肌酸激酶（CK）峰值升高500 mU/ml（比值比[OR] 1.24，95%置信区间[CI] 1.09 - 1.41，p = 0.001）、出院时心率增加5次/分钟（OR 1.39，95% CI 1.03 - 1.87，p = 0.03）、最终TIMI血流分级≤2（与TIMI 3级相比；OR 6.95，95% CI 1.70 - 28.36，p = 0.01）以及最终心肌灌注分级（MBG）≤2（与MBG 3级相比；OR 4.33，95% CI 1.06 - 17.66，p = 0.04）与LVAA的发生显著相关。初始TIMI血流分级或侧支血流分级与LVAA无关。总之，CK峰值、心率以及最终TIMI血流分级或最终MBG≤2与LVAA的发生显著相关。通过直接PCI达到TIMI血流3级对于预防LVAA可能很重要。
