De Luca Giuseppe, Parodi Guido, Sciagrà Roberto, Venditti Francesco, Bellandi Benedetta, Vergara Ruben, Migliorini Angela, Valenti Renato, Antoniucci David
Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy,
J Thromb Thrombolysis. 2014 Jul;38(1):81-6. doi: 10.1007/s11239-013-0977-x.
Despite optimal epicardial recanalization, primary angioplasty for STEMI is still associated with suboptimal reperfusion in a relatively large proportion of patients. The aim the current study was to evaluate the impact of preprocedural TIMI flow on myocardial scintigraphic infarct size among STEMI undergoing primary angioplasty. Our population is represented by 793 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Poor preprocedural TIMI flow (TIMI 0-1) was observed in 645 patients (81.3%). Poor preprocedural TIMI flow was associated with more hypercholesterolemia (p = 0.012), and a trend in lower prevalence of diabetes (p = 0.081). Preprocedural TIMI flow significantly affected scintigraphic and enzymatic infarct size. Similar findings were observed in the analysis restricted to patients with postprocedural TIMI 3 flow. The impact of preprocedural TIMI flow on scintigraphic infarct size was confirmed when the analysis was performed according to the percentage of patients above the median (p < 0.001) and after adjustment for baseline confounding factors (Hypercholesterolemia and diabetes) [adjusted OR (95% CI) for pre preprocedural TIMI 3 flow = 0.59 (0.46-0.75), p < 0.001]. This study shows that among patients with STEMI undergoing primary angioplasty, poor preprocedural TIMI flow is independently associated with larger infarct size.
尽管进行了最佳的心外膜血管再通治疗，但ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（primary angioplasty）后，仍有相当一部分患者存在再灌注不理想的情况。本研究的目的是评估直接经皮冠状动脉介入治疗前心肌梗死溶栓治疗（TIMI）血流对STEMI患者心肌闪烁显像梗死面积的影响。我们的研究对象为793例接受直接经皮冠状动脉介入治疗的STEMI患者。在30天时通过锝-99m-甲氧基异丁基异腈评估梗死面积。645例患者（81.3%）术前TIMI血流较差（TIMI 0-1级）。术前TIMI血流较差与更多的高胆固醇血症相关（p = 0.012），糖尿病患病率较低有一定趋势（p = 0.081）。术前TIMI血流显著影响闪烁显像和酶学梗死面积。在仅分析术后TIMI 3级血流的患者中也观察到了类似的结果。当根据中位数以上患者的百分比进行分析时（p < 0.001），以及在调整基线混杂因素（高胆固醇血症和糖尿病）后，术前TIMI血流对闪烁显像梗死面积的影响得到了证实[术前TIMI 3级血流的调整后比值比（95%可信区间）= 0.59（0.46-0.75），p < 0.001]。本研究表明，在接受直接经皮冠状动脉介入治疗的STEMI患者中，术前TIMI血流较差与更大的梗死面积独立相关。
