首次前壁心肌梗死成功溶栓后再闭塞对左心室大小和功能的长期影响。

Long-term implications of reocclusion on left ventricular size and function after successful thrombolysis for first anterior myocardial infarction.

作者信息

Nijland F, Kamp O, Verheugt F W, Veen G, Visser C A

机构信息

Department of Cardiology, Research School Free University Hospital, Amsterdam, Netherlands.

出版信息

Circulation. 1997 Jan 7;95(1):111-7. doi: 10.1161/01.cir.95.1.111.

DOI:10.1161/01.cir.95.1.111

PMID:8994425

Abstract

BACKGROUND

Successful thrombolysis can prevent left ventricular dilatation after acute myocardial infarction. However, in almost 30% of patients, reocclusion occurs. The aim of this study was to assess the long-term implications of reocclusion on left ventricular size and function.

METHODS AND RESULTS

Fifty-six patients were studied with two-dimensional echocardiography at baseline (2 +/- 1.6 days) and 5.0 +/- 1.4 years after first anterior myocardial infarction. All patients (a subset of those enrolled in the APRICOT trial) had a patent infarct-related artery when studied < 48 hours after thrombolysis and underwent repeat coronary angiography at 3 months. Baseline characteristics were comparable in patients with (n = 17) and without reocclusion (n = 39). Left ventricular volume indexes were stable in patients without reocclusion. Patients with reocclusion, however, showed a significant increase in end-diastolic volume index (EDVI; P = .008) and end-systolic volume index (ESVI; P = .039). Furthermore, patients without reocclusion demonstrated improvement in wall motion score index (WMSI; P = .0001) and ejection fraction (EF; P = .016), whereas patients with reocclusion did not. After 5 years, patients with reocclusion had significantly larger volume indexes (EDVI, 99 +/- 41 versus 76 +/- 22 mL/m2, P = .007; ESVI, 59 +/- 40 versus 39 +/- 20 mL/m2, P = .017) and more compromised left ventricular function (WMSI, 1.63 +/- 0.33 versus 1.39 +/- 0.32, P = .013; EF, 45 +/- 13% versus 51 +/- 11%, P = .077) than patients without reocclusion. Multivariate analysis identified baseline WMSI and reocclusion as significant independent predictors of left ventricular dilatation.

CONCLUSIONS

Reocclusion of the infarct-related artery within 3 months of successful thrombolysis is associated with left ventricular dilatation and is detrimental to functional recovery of left ventricular function 5 years after first anterior myocardial infarction.

摘要

背景

成功的溶栓治疗可预防急性心肌梗死后左心室扩张。然而，近30%的患者会发生再闭塞。本研究的目的是评估再闭塞对左心室大小和功能的长期影响。

方法与结果

对56例患者在首次前壁心肌梗死后基线期（2±1.6天）和5.0±1.4年时进行二维超声心动图检查。所有患者（APRICOT试验入组患者的一个子集）在溶栓后<48小时进行研究时梗死相关动脉通畅，并在3个月时接受重复冠状动脉造影。有再闭塞（n = 17）和无再闭塞（n = 39）患者的基线特征具有可比性。无再闭塞患者的左心室容积指数稳定。然而，有再闭塞的患者舒张末期容积指数（EDVI；P = .008）和收缩末期容积指数（ESVI；P = .039）显著增加。此外，无再闭塞的患者壁运动评分指数（WMSI；P = .0001）和射血分数（EF；P = .016）有所改善，而有再闭塞的患者则没有。5年后，有再闭塞的患者比无再闭塞的患者具有显著更大的容积指数（EDVI，99±41 vs 76±22 mL/m2，P = .007；ESVI，59±40 vs 39±20 mL/m2，P = .017）和更受损的左心室功能（WMSI，1.63±0.33 vs 1.39±0.32，P = .013；EF，45±13% vs 51±11%，P = .077）。多变量分析确定基线WMSI和再闭塞是左心室扩张的重要独立预测因素。