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目的:探讨急性ST段抬高心肌梗死(心梗)(STEMI)急诊经皮冠状动脉介入治疗(PCI)后心肌灌注不良的影响因素。方法:根据PCI后心肌梗死溶栓治疗(TIMI)心肌灌注分级(TMPG),91例患者分为心肌灌注不良组(TMPG0～2级,n=30)和心肌灌注正常组(TMPG3级,n=61),比较2组基本临床资料和造影结果以及介入结果,并对各因素进行Logistio回归分析,总结急性心梗急诊PCI后心肌灌注不良的影响因素。结果:91例患者中男76例,女15例,年龄38～84(62.3±11.8)岁,心肌灌注不良组合并高血压病的比例更高(80.0%比54.1%,P=0.0163),心梗部位以非前壁心梗居多(70.0%比29.5%,P=0.002);造影结果中,心肌灌注不良组梗死相关血管以右冠状动脉(RCA)更多见(63.3%比18.0%,P<0.0001),术前校正的TIMI血流帧数计数(CTFC)值[(97.7±12.6)帧比(87.3±26.4)帧,P=0.0414]和术前心肌呈色分级(MBG)0级的比例(93.3%比75.4%,P=0.0268)也是心肌灌注不良组更高;单因素回归分析显示高血压、非前壁心梗、发病至球囊开通时间、犯罪血管为RCA、术前MBG均是PCI后心肌灌注不良的预测因素,但多因素Logistio回归分析发现,仅发病至球囊开通时间是PCI后心肌灌注不良的独立危险因素。结论:高血压、非前壁心梗、犯罪血管为RCA、术前CTFC及术前MBG、发病至球囊开通时间均是PCI后TMPG的影响因素,其中发病至球囊开通时间是PCI后TMPG低的独立危险因素,发病至球囊开通时间越长,PCI后TMPG越低,心肌灌注越差。
Objective: To investigate the influencing factors of myocardial perfusion after percutaneous coronary intervention (PCI) in STEMI acute myocardial infarction (STEMI). Methods: According to the TIMI myocardial perfusion grading (TMPG) after PCI, 91 patients were divided into myocardial perfusion defect group (TMPG level 0 ~ 2, n = 30) and myocardial perfusion normal group (TMPG level 3, 61). The basic clinical data, radiography results and interventional outcomes of two groups were compared. Logistic regression analysis was used to analyze the influential factors of myocardial perfusion after acute myocardial infarction (PCI). Results: There were 76 males and 15 females in 91 cases, ranging in age from 38 to 84 (62.3 ± 11.8 years), with a higher proportion of patients with poor myocardial perfusion and hypertension (80.0% vs. 54.1%, P = 0.0163) The infarct size was predominantly non-anterior myocardial infarction (70.0% vs 29.5%, P = 0.002). In the angiographic results, the infarct-related vessels in the myocardial perfusion group were more common with right coronary artery (RCA) (63.3% vs 18.0%, P <0.0001), preoperatively corrected CTFC value [(97.7 ± 12.6) frame ratio (87.3 ± 26.4) frames, P = 0.0414], and preoperative myocardial grading (MBG) (93.3% vs 75.4%, P = 0.0268) were also higher in patients with myocardial perfusion. Univariate regression analysis showed that hypertension, non-anterior myocardial infarction, time to balloon occlusion and criminality were RCA, preoperative MBG Is a predictor of myocardial perfusion after PCI, but multivariate Logistio regression analysis found that the only time from onset to balloon occlusion was an independent risk factor for myocardial perfusion after PCI. CONCLUSIONS: Hypertension, non-anterior myocardial infarction, criminal blood vessels for RCA, preoperative CTFC and preoperative MBG, the time from onset to balloon occlusion were the influencing factors of TMPG after PCI. The onset time to balloon occlusion was TMPG after PCI Low independent risk factors, the onset of the balloon to open longer, lower TMPG after PCI, myocardial perfusion worse.