【摘要】 目的探讨梗死前心绞痛(PIA)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后无再流现象的影响。方法100例首次AMI患者均在发病12h内行PCI术。所有患者按照有无无再流现象分为2组:无再流组(15例)和再流组(85例)。监测心肌酶谱和C反应蛋白(CRP)变化;放射性核素测定心功能;观察室壁瘤、心力衰竭发生率和住院病死率。结果无再流组PIA发生率显著低于再流组(P<0.01);而前壁梗死的发生率高于再流组(P<0.05);肌酸激酶同工酶峰值和CRP水平均显著高于再流组(P<0.01)。无再流组放射性缺损面积显著大于再流组(P<0.01);左室射血分数显著低于再流组(P<0.01);心力衰竭、室壁瘤发生率和死亡率均高于再流组(P<0.05)。多元Logistic回归分析结果显示,缺乏PIA是发生无再流现象的独立预测因素(OR=6.12,P=0.01)。结论缺乏PIA是发生无再流现象的独立预测因素,而无再流现象与心力衰竭和死亡率增高密切相关。更多还原

【Abstract】 Objective To evaluate effects of preinfarction angina on no-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods 100 patients with first AMI were divided into no-reflow group (n=15) and reflow group (n=85). All patients underwent PCI within 12 h after onset of AMI. No-reflow phenomenon, defined as TIMI grade 2 flow or less without apparent residual stenosis in infarct-related artery (IRA). Myocardial enzyme and C-reactive protein were continuously measured; left ventricular function was assessed by radionuclideimaging; the incidence of ventricular aneurysm, heart failure and mortality in hospital were observed. Results (1)Patients with no-reflow had a significantly lower incidence of preinfarction angina (P<0.01), a higher rate of anterior infarction (P<0.05),and had significantly higher peak creatine isozyme fraction and C-reactive protein than those with reflow (P<0.01). (2) Patients with no-reflow had significantly larger myocardial infarction size (MIS) (P<0.01), significantly lower left ventricular ejection fraction (P<0.01), and had a higher incidence of ventricular aneurysm, heart failure and mortality than those with reflow (P<0.05). (3)Multivariate Logistic analysis showed that the Absence of preinfarction angina was a major independent determinant of no-reflow phenomenon (OR=6.12, P=0.01). Conclusions The Absence of preinfarction angina is a independent predictor of no-reflow phenomenon; whereas no-reflow phenomenon is closely associated with the increased incidence of heart failure and mortality.更多还原