Kanamasa K, Ogawa I, Koka H, Ishida N, Sasaki T, Nakabayashi T, Nakagawa K, Takada K, Kato H, Otani N, Ishikawa K, Katori R
First Department of Internal Medicine, Kinki University School of Medicine, Osaka.
J Cardiol. 1996 Oct;28(4):199-205.
The prevention of left ventricular aneurysm formation and left ventricular remodeling by percutaneous transluminal coronary angioplasty (PTCA) performed 24 to 48 hours after onset of acute myocardial infarction was investigated. Left ventriculography and coronary angiography were performed in 25 patients within 24 hours of onset of acute myocardial infarction. The patients were divided into two groups; reperfusion group (n = 17) and successful PTCA group (n = 8). The reperfusion group and the PTCA group included patients whose infarct-related coronary arteries were successfully reperfused to 99%, Thrombolysis in Myocardial Infarction (TIMI) grade II or III, immediately after coronary thrombolysis. However, the reperfusion group did not include the patients with spontaneous reperfusion or reperfusion after PTCA. The PTCA group consisted of patients who underwent successful PTCA performed within 24 to 48 hours after onset of infarction (mean 28.4 +/- 6.0 hours). Non-reperfusion in the acute phase was defined as TIMI grade 0-I. The size of the ventricular aneurysm in the PTCA group was significantly reduced compared with the reperfusion group (PTCA group 4.2 +/- 8.7%, reperfusion group 27.2 +/- 6.6%; p < 0.01). The increase of left ventricular end-diastolic volume (delta LVEDVI) from the acute to chronic phases was calculated to estimate left ventricular remodeling. There was a significant difference between the two groups in delta LVEDVI (PTCA group 4 +/- 19 ml/m2, reperfusion group 19 +/- 17 ml/m2; p < 0.05). PTCA performed within 24 to 48 hours after onset in patients with acute myocardial infarction and infarct-related coronary arteries, resulting in reperfusion to 99% TIMI grade II or III immediately after coronary thrombolysis, prevents left ventricular aneurysm formation and remodeling.
研究了在急性心肌梗死发病24至48小时后进行经皮腔内冠状动脉成形术（PTCA）对预防左心室动脉瘤形成和左心室重塑的作用。对25例急性心肌梗死发病24小时内的患者进行了左心室造影和冠状动脉造影。患者分为两组：再灌注组（n = 17）和成功PTCA组（n = 8）。再灌注组和PTCA组均包括冠状动脉溶栓后梗死相关冠状动脉立即成功再灌注至99%、心肌梗死溶栓（TIMI）分级为II或III级的患者。然而，再灌注组不包括自发再灌注或PTCA后再灌注的患者。PTCA组由梗死发病后24至48小时内（平均28.4 +/- 6.0小时）成功进行PTCA的患者组成。急性期未再灌注定义为TIMI 0 - I级。与再灌注组相比，PTCA组的心室动脉瘤大小显著减小（PTCA组4.2 +/- 8.7%，再灌注组27.2 +/- 6.6%；p < 0.01）。计算从急性期到慢性期左心室舒张末期容积的增加量（ΔLVEDVI）以评估左心室重塑。两组在ΔLVEDVI方面存在显著差异（PTCA组4 +/- 19 ml/m²，再灌注组19 +/- 17 ml/m²；p < 0.05）。对于急性心肌梗死且梗死相关冠状动脉的患者，在发病后24至48小时内进行PTCA，导致冠状动脉溶栓后立即再灌注至99% TIMI II或III级，可预防左心室动脉瘤形成和重塑。
