Department of Radiology and Nuclear Medicine, Division of Diagnostics and Intervention, Oslo University Hospital, Ullevål, Norway.
EuroIntervention. 2015 Sep;11(5):518-24. doi: 10.4244/EIJY15M04_02.
Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) usually restores TIMI 3 flow in the occluded artery, but microvascular impairment may persist in >30% of patients. Less is known about microvascular reperfusion in STEMI patients treated with thrombolysis followed by early PCI. We aimed to assess the association between TIMI myocardial perfusion (TMP) at the end of the PCI procedure and left ventricular function (LVEF) and infarct size after three months in such patients.
Patients with STEMI treated with thrombolysis and early PCI were included. TMP grade was assessed at the end of the PCI procedure, and MRI was performed after three months. Of the 89 patients included, 92% (n=82) had TIMI 3 flow at the end of the PCI procedure, while only 62% (n=55) had TMP grade 2 or 3. Patients with TMP grade 2-3 had significantly higher LVEF (59% [53-67] vs. 50% [41-56], p<0.0001) and smaller infarct size (8.3 ml [2.7-15.5] vs. 20.7 ml [13.0-36.0], p<0,0001) after three months.
In STEMI patients treated with thrombolysis and early PCI, the TMP grade at the end of the PCI procedure was significantly associated with LVEF and infarct size after three months.
经皮冠状动脉介入治疗（PCI）治疗 ST 段抬高型心肌梗死（STEMI）通常可使闭塞动脉恢复 TIMI 3 级血流，但仍有＞30%的患者存在微血管损伤。溶栓后早期 PCI 治疗 STEMI 患者的微血管再灌注情况了解较少。本研究旨在评估 PCI 术后即刻 TIMI 心肌灌注（TMP）分级与此类患者 3 个月时左心室功能（LVEF）和梗死面积的相关性。
本研究纳入了接受溶栓和早期 PCI 治疗的 STEMI 患者。在 PCI 术后即刻评估 TMP 分级，并在 3 个月后进行 MRI 检查。89 例患者中，92%（n=82）患者在 PCI 术后即刻达到 TIMI 3 级血流，而仅有 62%（n=55）患者的 TMP 分级为 2 级或 3 级。TMP 分级为 2-3 级的患者 LVEF 明显更高（59%[53-67] vs. 50%[41-56]，p＜0.0001），梗死面积更小（8.3 ml[2.7-15.5] vs. 20.7 ml[13.0-36.0]，p＜0.0001）。
在接受溶栓和早期 PCI 治疗的 STEMI 患者中，PCI 术后即刻的 TMP 分级与 3 个月后的 LVEF 和梗死面积显著相关。
