Santoro G M, Valenti R, Buonamici P, Bolognese L, Cerisano G, Moschi G, Trapani M, Antoniucci D, Fazzini P F
Division of Cardiology, Careggi Hospital, Florence, Italy.
Am J Cardiol. 1998 Oct 15;82(8):932-7. doi: 10.1016/s0002-9149(98)00508-6.
The aim of this study was to evaluate the relation between myocardial perfusion and ST-segment changes in patients with acute myocardial infarction treated with successful direct angioplasty. Thirty-seven patients, successfully treated with direct angioplasty, underwent myocardial contrast echocardiography before and after angioplasty. The sum of ST-segment elevation divided by the number of the leads involved (ST-segment elevation index) was calculated at 1, 5, 10, 20, and 30 minutes after restoration of a Thrombolysis In Myocardial Infarction trial grade 3 flow. After recanalization, myocardial reperfusion within the risk area was observed in 26 patients, whereas a no-reflow phenomenon occurred in 11. In patients with myocardial reperfusion, the ST-segment elevation index progressively declined, whereas in patients with no reflow, no significant change was observed. Reduction of > or = 50% in the ST-segment elevation index occurred in 20 of the 26 patients with reflow and in 1 of the 11 with no reflow (p = 0.0002). An additional increase of > or = 30% in the ST-segment elevation index occurred in 3 patients with reflow and in 7 with no reflow (p = 0.003). Sensitivity, specificity, positive and negative predictive values, and accuracy of the reduction in the ST-segment elevation index for predicting microvascular reflow were 77%, 91%, 95%, 62%, and 81%, respectively. The corresponding values of the increase in ST-segment elevation index for predicting no reflow were 64%, 88%, 70%, 85%, and 81%, respectively. In conclusion, after successful angioplasty, different patterns of myocardial perfusion are associated with different ST-segment changes. Analysis of ST-segment changes predicts the degree of myocardial reperfusion.
本研究旨在评估成功接受直接血管成形术治疗的急性心肌梗死患者心肌灌注与ST段改变之间的关系。37例成功接受直接血管成形术治疗的患者在血管成形术前后接受了心肌对比超声心动图检查。在恢复心肌梗死溶栓试验3级血流后的1、5、10、20和30分钟计算ST段抬高总和除以受累导联数（ST段抬高指数）。再通后，26例患者在危险区域内观察到心肌再灌注，而11例出现无复流现象。在心肌再灌注患者中，ST段抬高指数逐渐下降，而在无复流患者中未观察到显著变化。26例有复流的患者中有20例ST段抬高指数降低≥50%，11例无复流患者中有1例降低≥50%（p = 0.0002）。3例有复流患者和7例无复流患者ST段抬高指数额外增加≥30%（p = 0.003）。ST段抬高指数降低用于预测微血管再流的敏感性、特异性、阳性和阴性预测值以及准确性分别为77%、91%、95%、62%和81%。ST段抬高指数增加用于预测无复流的相应值分别为64%、88%、70%、85%和81%。总之，成功血管成形术后，不同模式的心肌灌注与不同的ST段改变相关。ST段改变的分析可预测心肌再灌注程度。
