通过再灌注的临床标志物区分溶栓治疗后的冠状动脉再灌注和心肌再灌注。

The distinction between coronary and myocardial reperfusion after thrombolytic therapy by clinical markers of reperfusion.

作者信息

Matetzky S, Freimark D, Chouraqui P, Novikov I, Agranat O, Rabinowitz B, Kaplinsky E, Hod H

机构信息

Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel.

出版信息

J Am Coll Cardiol. 1998 Nov;32(5):1326-30. doi: 10.1016/s0735-1097(98)00417-3.

DOI:10.1016/s0735-1097(98)00417-3

PMID:9809943

Abstract

OBJECTIVES

We sought to examine the hypothesis that rapid resolution of ST-segment elevation in acute myocardial infarction (AMI) patients with early peak creatine kinase (CK) after thrombolytic therapy differentiates among patients with early recanalization between those with and those without adequate tissue (myocardial) reperfusion.

BACKGROUND

Early recanalization of the epicardial infarct-related artery (IRA) during AMI does not ensure adequate reperfusion on the myocardial level. While early peak CK after thrombolysis results from early and abrupt restoration of the coronary flow to the infarcted area, rapid ST-segment resolution, which is another clinical marker of successful reperfusion, reflects changes of the myocardial tissue itself.

METHODS

We compared the clinical and the angiographic results of 162 AMI patients with early peak CK (< or =12 h) after thrombolytic therapy with (group A) and without (group B) concomitant rapid resolution of ST-segment elevation.

RESULTS

Patients in groups A and B had similar patency rates of the IRA on angiography (anterior infarction: 93% vs. 93%; inferior infarction: 89% vs. 77%). Nevertheless, group A versus B patients had lower peak CK (anterior infarction: 1,083+/-585 IU/ml vs. 1,950+/-1,216, p < 0.01; and inferior infarction: 940+/-750 IU/ml vs. 1,350+/-820, p=0.18) and better left ventricular ejection fraction (anterior infarction: 49+/-8, vs. 44+/-8, p < 0.01; inferior infarction: 56+/-12 vs. 51+/-10, p=0.1). In a 2-year follow-up, group A as compared with group B patients had a lower rate of congestive heart failure (1% vs. 13%, p < 0.01) and mortality (2% vs. 13%, p < 0.01).

CONCLUSIONS

Among patients in whom reperfusion appears to have taken place using an early peak CK as a marker, the coexistence of rapid resolution of ST-segment elevation further differentiates among patients with an opened culprit artery between the ones with and without adequate myocardial reperfusion.

摘要

目的

我们试图检验这样一个假设，即急性心肌梗死（AMI）患者在溶栓治疗后肌酸激酶（CK）早期峰值出现时ST段抬高的快速消退，可区分梗死相关动脉（IRA）开通的患者中，心肌再灌注充分与不充分者。

背景

急性心肌梗死期间梗死相关心外膜动脉（IRA）的早期再通并不能确保心肌水平的充分再灌注。溶栓后CK早期峰值是由于梗死区域冠状动脉血流的早期突然恢复所致，而ST段快速消退作为再灌注成功的另一个临床指标，反映了心肌组织本身的变化。

方法

我们比较了162例溶栓治疗后CK早期峰值（≤12小时）的AMI患者的临床和血管造影结果，其中伴有ST段抬高快速消退的患者为A组，不伴有者为B组。

结果

A组和B组患者IRA的血管造影通畅率相似（前壁梗死：93%对93%；下壁梗死：89%对77%）。然而，A组患者与B组患者相比，CK峰值较低（前壁梗死：1083±585 IU/ml对1950±1216，p<0.01；下壁梗死：940±750 IU/ml对1350±820，p=0.18），左心室射血分数更好（前壁梗死：49±8对44±8，p<0.01；下壁梗死：56±12对51±10，p=0.1）。在2年的随访中，与B组患者相比，A组患者的充血性心力衰竭发生率较低（1%对13%，p<0.01），死亡率也较低（2%对13%，p<0.01）。