ST段抬高型心肌梗死（STEMI）直接血管成形术后再灌注失败的危险因素

Risk Factors of Reperfusion Failure following Primary Angioplasty for ST-Segment Elevation Myocardial Infarction (STEMI).

作者信息

Sanati Hamid Reza, Mahjoob Mohammad Parsa, Zahedmehr Ali, Ghahferokhi Farshad Shakerian, Firoozi Ata, Kiani Reza, Sadeghi Zohreh, Diz Abolfath Alizadeh, Abkenar Hooman Bakhshandeh

机构信息

Cardiovascular Intervention Research Center, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Cardiovacsular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

J Tehran Heart Cent. 2013 Jul;8(3):146-51. Epub 2013 Jul 30.

PMID:24396364

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3874374/

Abstract

BACKGROUND

Although percutaneous coronary intervention (PCI) improves outcomes compared to thrombolysis, a substantial number of ST-elevation myocardial infarction (STEMI) patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI.

METHODS

Totally, 155 patients (124 men; mean age = 56.6 ± 11.03 years, range = 31- 85 years) with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed.

RESULTS

Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GPIIb/IIIa inhibitor were not the determining factors (p value > 0.05). According to our multivariate analysis, time of symptom onset (OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044) and ejection fraction (OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050) had reverse and male gender had direct significant associations with failed reperfusion (OR [95% CI]: 0.34 [0.11 to 1.08]; p value = 0.068). More degrees of ST resolution occurred when the right coronary artery was the culprit vessel (p value = 0.001). The presence of more than three cardiac risk factors was associated with failed reperfusion (p value = 0.050).

CONCLUSION

Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy.

摘要

背景

尽管与溶栓治疗相比，经皮冠状动脉介入治疗（PCI）能改善治疗结果，但仍有相当数量的ST段抬高型心肌梗死（STEMI）患者未能实现最佳心肌再灌注。本研究旨在评估STEMI患者直接PCI术后心肌再灌注未达最佳状态的相关因素。

方法

对155例行直接PCI的STEMI患者（124例男性；平均年龄=56.6±11.03岁，范围=31-85岁）进行回顾性研究。此外，分析了再灌注失败的发生与年龄、性别、心脏危险因素、家族史、体重指数、症状发作时间、射血分数、既往PCI、冠状动脉旁路移植术或既往心肌梗死等变量以及血管造影数据之间的关系。

结果

手术成功率为97.1%，43.2%的患者ST段完全恢复。年龄、心脏危险因素、家族史、体重指数、既往心肌梗死、冠状动脉旁路移植术或PCI、血栓切除术装置和糖蛋白IIb/IIIa抑制剂的使用均不是决定因素（p值>0.05）。根据多因素分析，症状发作时间（OR[95%CI]：0.45[0.2至0.98]；p值=0.044）和射血分数（OR[95%CI]：0.