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目的探讨老年急性心肌梗死(acute myocardial infarction,AMI)-急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心肌组织水平再灌注状态不良的发生率及其对近、远期临床预后的影响。方法回顾性收集398例老年急性ST段抬高心肌梗死(ST-elevationmyocardi-alinfarction,STEMI)行急诊PCI治疗患者的临床资料、冠状动脉造影资料与心电图,以ST段回落程度与TIMI心肌灌注(TIMIMyocardialPerfusion,TMP)分级等指标评估心肌组织水平再灌注状态,患者分为4组,A组为ST段回落率>50%并且术后TMP分级为Ⅲ级;B组为ST段回落率<50%而术后TMP分级=Ⅲ级;C组为术后TMP分级≤Ⅱ级而ST段回落率>50%;D组为ST段回落率<50%并且术后TMP分级≤Ⅱ级。分析心肌组织水平再灌注不良患者的发生率及其对近远期预后的影响。结果 STEMI急诊PCI术后梗死相关血管(infarctionrelatedartery,IRA)前向血流达到TIMIⅢ级而TMP分级为Ⅱ级以下者占37.2%,心电图ST段回落小于50%者占37.2%,均接近1/3。12.5%的患者具有远端栓塞。术后ST段回落率>50%并且TMP分级为Ⅲ级者占总人数的39.8%,ST段回落率<50%,并且术后TMP分级≤Ⅱ级占总人数的14.3%。心肌组织灌注状态不良者与心肌组织灌注状态良好者相比平均住院日更长,左室EF值更低,梗死后心绞痛发生率更高,远端栓塞发生率更高,IABP辅助应用比率更大,心功能恶化、心脏性死亡更高。与D组相比,随访期间MACE的发生风险在C组为43%(P=0.11),在B组为24%(P<0.01),在A组为2.7%(P<0.01)。结论老年急性心肌梗死行急诊PCI治疗后IRA再通者仅有不到40%的患者其心肌组织水平得到了良好的再灌注,其近、远期预后较好,而剩余约60%的患者其心肌组织水平存在不同程度的再灌注障碍,其中有大概约超过10%的患者其心肌组织水平存在较差的再灌注状态,这些患者在住院期间以及远期随访期间有着极高的MACE发生风险。
Objective To investigate the incidence of myocardial ischemia and reperfusion in elderly patients with acute myocardial infarction (AMI) and emergency percutaneous coronary intervention (PCI) and its effect on clinical outcome . Methods The clinical data, coronary angiography data and electrocardiogram of 398 elderly patients with acute ST-elevation myocardial infarction (STEMI) undergoing PCI were retrospectively collected. The changes of ST segment depression and TIMI myocardial perfusion , TMP) were used to assess the level of myocardial reperfusion. The patients were divided into 4 groups. The patients in group A had a ST-segment resolution of> 50% and postoperative TMP grade of grade 3. The patients in group B had an ST-segment resolution of <50% Postoperative TMP grade = grade III; group C postoperative TMP grade ≤ grade Ⅱ and ST segment resolution> 50%; group D ST segment resolution <50% and postoperative TMP grade ≤ grade Ⅱ. Analysis of the incidence of myocardial ischemia in patients with poor reperfusion and its impact on short-term prognosis. Results The antegrade flow of infarction related artery (IRA) to TIMI Ⅲ level after STEMI and 37.2% of patients with TMP grade Ⅱ or less were less than 50% in STEM, all of which were close to 1/3 12.5% of patients had distal embolism. Postoperative ST-segment resolution was> 50% and TMP grade III was 39.8% of the total, ST-segment resolution was <50%, and postoperative TMP grade II was 14.3% of the total. Patients with poor myocardial perfusion and myocardial perfusion had longer average length of stay, lower left ventricular EF, higher incidence of angina after infarction, higher incidence of distal embolism, and greater rates of IABP-assisted use , Worsening heart function, cardiac death higher. Compared with group D, the risk of MACE during follow-up was 43% in group C (P = 0.11), 24% in group B (P <0.01) and 2.7% in group A (P <0.01). Conclusions Only 40% of patients with recanalization after PCI in elderly patients with acute myocardial infarction have good reperfusion of myocardial tissue, and their prognosis is good in short-term and long-term, while in the remaining 60% of patients There are varying degrees of reperfusion disruption at the level of myocardial tissue, with approximately 10% of patients having poor myocardial tissue reperfusion status, and these patients have a very high risk of MACE during hospitalization and long-term follow-up.