Schwarz F, Schuler G, Hofmann M, Manthey J, Mehmel H C, Kübler W
Z Kardiol. 1984 Apr;73(4):231-6.
In 28 patients the effect of coronary artery reperfusion in acute transmural myocardial infarction was evaluated by the clinical and hemodynamic results obtained after 15 months. Patients with successful reperfusion within 4 hours after onset of symptoms were assembled in group A1 (n = 11), patients with successful reperfusion after more than 4 hours in group A2 (n = 7). Group B consists of 10 patients with unsuccessful reperfusion. Left ventricular ejection fraction (radionuclide ventriculography) and the perfusion defect (thallium-201 scintigraphy) were measured acutely and after 15 months (at rest and during exercise). The coronary anatomy and the regional ejection fraction of infarct area were determined acutely and after 4 weeks by cineangiography. Serum creatine kinase activity was measured serially during the acute phase of the infarction. Before the acute intervention, the patients of the 3 groups were comparable with regard to killip class, location of infarction, number of previous infarctions, coronary anatomy, left ventricular ejection fraction, thallium-201 perfusion defect and base-line serum creatine kinase activity. During acute infarction peak creatine kinase activity tended to be lower in group A1 (1296 U/l) than in group A2 (2100 U/l, NS) and in group B (2240 U/l, NS). After 4 weeks regional ejection fraction of infarct area was higher in group A1 (36%) than in groups A2 (24%, NS) and B (20%, p less than 0.05). After 15 months the thallium-201 perfusion defect was smaller in group A1 (7%) than in groups A2 (28%, p less than 0.05) and B (34%, p less than 0.01). At the same time left ventricular ejection fraction was higher in group A1 (52%) than in groups A2 (34%, p less than 0.05) and B (35%, p less than 0.05). Fifteen months after acute infarction patients in group A1 tended to reach a higher workload during exercise (118 watts) compared with patients of groups A2 (82 watts, NS) and B (86 watts, NS).(ABSTRACT TRUNCATED AT 250 WORDS)
通过15个月后获得的临床和血流动力学结果，对28例急性透壁性心肌梗死患者冠状动脉再灌注的效果进行了评估。症状发作后4小时内成功再灌注的患者被归入A1组（n = 11），症状发作4小时后成功再灌注的患者被归入A2组（n = 7）。B组由10例再灌注未成功的患者组成。在急性期和15个月后（静息和运动时）测量左心室射血分数（放射性核素心室造影）和灌注缺损（铊-201闪烁显像）。通过电影血管造影术在急性期和4周后确定冠状动脉解剖结构和梗死区域的局部射血分数。在梗死急性期连续测量血清肌酸激酶活性。在急性干预前，三组患者在Killip分级、梗死部位、既往梗死次数、冠状动脉解剖结构、左心室射血分数、铊-201灌注缺损和基线血清肌酸激酶活性方面具有可比性。在急性梗死期间，A1组肌酸激酶活性峰值（1296 U/l）往往低于A2组（2100 U/l，无显著性差异）和B组（2240 U/l，无显著性差异）。4周后，A1组梗死区域的局部射血分数（36%）高于A2组（24%，无显著性差异）和B组（20%，p<0.05）。15个月后，A1组铊-201灌注缺损（7%）小于A2组（28%，p<0.05）和B组（34%，p<0.01）。同时，A1组左心室射血分数（52%）高于A2组（34%，p<0.05）和B组（35%，p<0.05）。急性梗死后15个月，与A2组（82瓦，无显著性差异）和B组（86瓦，无显著性差异）患者相比，A1组患者在运动时往往能达到更高的工作量（118瓦）。（摘要截断于250字）
