急性心肌梗死经皮冠状动脉介入治疗后心肌灌注的方法评价

被引：25

作者：

魏芳晶

张福春

毛节明

郭丽君

李海燕

牛杰

赵一鸣

吕旌桥

郭静萱

高炜

机构：

[1] 北京大学第三医院心内科

[2] 北京大学医学部临床流行病学教研室

来源：

中华心血管病杂志 | 2004年 / 10期

关键词：

心肌梗塞; 血管成形术,经腔,经皮冠状动脉; 灌流;

D O I：

暂无

中图分类号：

R542.22 [];

学科分类号：

摘要：

目的　联合应用TIMI心肌灌注分级 (TMP)、校正的TIMI画面记帧 (CTFC)、心电图ST段变化 (sumSTR)方法评价急性心肌梗死 (AMI)急诊经皮冠状动脉介入治疗 (PCI)后心肌灌注程度 ,探讨心肌灌注程度对临床预后的影响。方法　 77例AMI患者PCI后即刻采用TMP +CTFC、TMP +sumSTR、CTFC +sumSTR三种联合方法评价心肌灌注程度 ,PCI术后 1个月检查双核素心肌灌注显像 ,记录 6个月心脏事件。结果　评价心肌灌注程度 ,与双核素心肌灌注显像对比 ,TMP +sumSTR敏感性 86 7%、特异性 85 7%、准确性 86 2 % ;TMP +CTFC敏感性 80 %、特异性 77 1%、准确性 78 5 % ;多变量回归分析TMP 0 / 1级 +sumSTR <30 %为 6个月心脏事件的独立危险因子 (OR=2 1 5 ,95 %可信区间 2 7～ 6 5 7,P =0 0 0 3) ;Kaplan Meier分析曲线显示TMP +sumSTR方法评价的心肌灌注不良组 6个月心脏事件高于心肌灌注良好组 (P <0 0 5 )。结论　TMP +sumSTR、TMP+CTFC能更好的评价心肌灌注程度 ;TMP +sumSTR可预测 6个月心脏事件。

引用

页码：9 / 12

页数：4

共 10 条

[1]

Incidence and treatment of‘no-reflow’after percutaneous coronary intervention. Piana RN,Paik GY,Moscucci M,et al. Circulation . 1994

[2]

Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. Ito H,Taniyama Y,Iwakura K,et al. Journal of the American College of Cardiology . 1999

[3]

Incomplete resolution of ST-segment elevation is a marker of transient microcirculatory dysfunction after stenting for acute myocardial infarction. Feldman LJ,Coste P,Furber A,et al. Circulation . 2003

[4]

Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction:myocardial blush grade. van′t Hof AW,Liem A,Suryapranata H,et al. Zwolle Myocardial Infarction Study Group.Circulation . 1998

[5]

Ability of the no-reflow phenomenon during an acute myocardial infarction to predict left ventricular dysfunction at one-month follow-up. Kenner MD,Zajac EJ,Kondos GT,et al. The American Journal of Cardiology . 1995

[6]

TIMI frame count: aquantitative method of assessing coronary artery flow. Gibson CM,Cannon CP,DaleyWL, et al. Circulation . 1996

[7]

Prediction of clinical outcome after mechanical revascularization in acute myocardial infarction by markers of myocardial reperfusion. Haager PK,Christott P,Heussen N,et al. Journal of the American College of Cardiology . 2003

[8]

Relationship between TIMI frame count and clinical outcomes after thrombolytic administration.Thrombolysis In Myocardial Infarction ( TIMI ) Study Group. Gibson CM,Murphy SA,Rizzo MJ,et al. Circulation . 1999

[9]

ST-segment recovery adds to the assessment of TIMI 2 and 3 flow in predicting infarct wall motion after thrombolytic therapy. Andrews J,Straznicky I T,French J K,et al. Circulation . 2000

[10]

Prog-nostic implications of TIMI flow grade in the in-farct related artery compared with continuous 12-lead ST-segment resolution analysis: re-examining the "gold standard" for myocardial reperfusion assessment. Shah A,Wagner GS,Granger CB,et al. Journal of the American College of Cardiology . 2000

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