Sakuma T, Hayashi Y, Sumii K, Imazu M, Yamakido M
Division of Cardiology, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
J Am Coll Cardiol. 1998 Oct;32(4):890-7. doi: 10.1016/s0735-1097(98)00342-8.
This study sought to determine whether microvascular integrity in the risk area (RA) for myocardial infarction (MI) one day after recanalization predicts the outcome in patients with first acute MI.
Immediately after recanalization, microcirculation in the RA is modified by both hyperemic response and microvascular impairment.
Fifty consecutive patients who underwent serial myocardial contrast echocardiography before and one day after recanalization (day 2) were studied. All patients had a completely occluded lesion in the left anterior descending coronary artery alone, and underwent successful reperfusion therapy. The relative size of the initial RA (RA ratio) and peak gray scale ratio (PGSR) within the RA on day 2 were determined. Patients were followed for a median of 22 months to evaluate clinical outcome.
On day 2, PGSR was a median of 0.46. Study patients were subdivided into two groups, group A of 24 patients with acceptable opacification (PGSR > 0.46 on day 2) and group B of 26 patients without it. Major cardiac events (cardiac death, nonfatal MI and repeat admission for congestive heart failure) were more frequently observed in group B (28% vs. 4%, Cox hazard ratio=8.5, p=0.05, 95% confidence interval [CI] 1.03 to 69.9). The median value of the RA ratio was 0.45. Patients (n=15) with RA ratio > 0.45 on day 1 and PGSR on day 2 < or = 0.46 exhibited a 10.7-fold relative risk for major cardiac events (p=0.005, 95% CI 2.06 to 55.8) and a 3.69-fold relative risk for composite cardiac events (major cardiac events and target lesion revascularizations) after the initial intervention (p=0.004, 95% CI 1.51 to 9.04).
The assessment of both the size of the initial RA and microvascular integrity on day 2 enables precise determination of the efficacy of reperfusion therapy and prediction of the short- and intermediate-term prognoses of patients with recanalized MI.
本研究旨在确定心肌梗死（MI）再灌注一天后梗死相关区域（RA）的微血管完整性是否可预测首次急性MI患者的预后。
再灌注后即刻，RA的微循环会因充血反应和微血管损伤而发生改变。
对50例连续患者进行研究，这些患者在再灌注前及再灌注后一天（第2天）接受了系列心肌对比超声心动图检查。所有患者仅左前降支冠状动脉有完全闭塞病变，并接受了成功的再灌注治疗。确定第2天初始RA的相对大小（RA比率）和RA内的峰值灰度比（PGSR）。对患者进行了中位时间为22个月的随访以评估临床结局。
在第2天，PGSR的中位数为0.46。研究患者被分为两组，A组24例患者造影剂充盈良好（第2天PGSR>0.46），B组26例患者造影剂充盈不佳。B组更频繁地观察到主要心脏事件（心源性死亡、非致死性MI和因充血性心力衰竭再次入院）（28%对4%，Cox风险比=8.5，p=0.05，95%置信区间[CI]1.03至69.9）。RA比率的中位数为0.45。第1天RA比率>0.45且第2天PGSR≤0.46的患者（n=15）发生主要心脏事件的相对风险为10.7倍（p=0.005，95%CI 2.06至55.8），初始干预后发生复合心脏事件（主要心脏事件和靶病变血运重建）的相对风险为3.69倍（p=0.004，95%CI 1.51至9.04）。
对初始RA大小和第2天微血管完整性的评估能够精确确定再灌注治疗的疗效，并预测再灌注MI患者的短期和中期预后。
