Zencirci Aycan Esen, Zencirci Ertugrul, Degirmencioglu Aleks, Karakus Gultekin, Ugurlucan Murat, Gunduz Sabahattin, Ozden Kivilcim, Erdem Aysun, Karadeniz Fatma, Ekmekci Ahmet, Erer Hatice, Sayar Nurten, Eren Mehmet
Department of Cardiology, Acıbadem Maslak Hospital.
Kardiol Pol. 2014;72(6):494-503. doi: 10.5603/KP.a2013.0355. Epub 2014 Jan 10.
Clinical outcomes of patients with myocardial infarction are primarily determined by the successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis.
To investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI).
The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimetres was obtained before angioplasty and 60 min after pPCI. ΣSTR < 50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading was calculated according to the results of coronary angiography, and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to STR: those with STR(-), and those with STR(+). Patients were also analysed according to the infarct-related artery.
GS-pPCI was significantly higher in patients with STR(-) (10.1 ± 11.8 vs. 22 ± 18.6, p = 0.005). GS-pPCI was inversely correlated with STR (r = -0.287, p = 0.002). In subgroup analysis, patients in the STR(-) group with culprit lesion in left anterior descending artery and left circumflex artery also showed higher GS-pPCI (10.9 ± 13.5 vs. 23.5 ± 21.3, p = 0.03 and 9.6 ± 8.7 vs. 24.1 ± 21, p = 0.04, respectively). High thrombus burden was also observed more frequently in patients with STR(-) (68% vs. 43%, p = 0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR 1.07, 95% CI 1.03-1.12, p = 0.001 and OR 3.28, 95% CI1.11-9.72, p = 0.03, respectively).
GS-pPCI and high thrombus burden play an important role in predicting inadequate STR in patients with STEMI treated with pPCI.
心肌梗死患者的临床结局主要取决于心肌再灌注的成功恢复以及冠状动脉粥样硬化的严重程度。
探讨Gensini评分对急性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（pPCI）时ST段回落（STR）的预测价值。
本研究前瞻性纳入了114例连续接受成功pPCI的STEMI患者（平均年龄54±10岁，女性15例）。在血管成形术前和pPCI后60分钟获取ST段抬高量（以毫米为单位）的总和。ΣSTR<50%被视为无复流现象的心电图表现。根据冠状动脉造影结果计算血栓分级，并且在不纳入罪犯病变的情况下于pPCI后计算Gensini评分（GS-pPCI）。根据STR将患者分为两组：STR（-）组和STR（+）组。还根据梗死相关动脉对患者进行分析。
STR（-）组患者的GS-pPCI显著更高（10.1±11.8对22±18.6，p=0.005）。GS-pPCI与STR呈负相关（r=-0.287，p=0.002）。在亚组分析中，左前降支和左旋支有罪犯病变的STR（-）组患者也显示出更高的GS-pPCI（分别为10.9±13.5对23.5±21.3，p=0.03；9.6±8.7对24.1±21，p=0.04）。STR（-）组患者中高血栓负荷也更常见（68%对43%，p=0.03）。多因素逻辑回归分析表明，GS-pPCI和高血栓负荷独立预测STR不足（OR分别为1.07，95%CI 1.03-1.12，p=0.001；OR 3.28，95%CI 1.11-9.72，p=0.03）。
GS-pPCI和高血栓负荷在预测接受pPCI治疗的STEMI患者STR不足方面起重要作用。
