急性前壁心肌梗死经皮冠状动脉血运重建术后ST段持续抬高对其晚期左室功能的影响  

Persistent ST-segment elevation after percutanous coronary intervention reduce the late phase left ventricular function in acute anterior wall myocardial infarction

作　　者：马礼坤[1] 余华[1] 黄向阳[1] 褚俊[1] 冯克福[1] 李世光 张晓红[3] 邵正斌[4] 丁晓梅[1] 严激[1] 顾统元[1] 

机构地区：[1]安徽省立医院心内科,合肥230001 [2]滁洲市第二医院心内科 [3]合肥市第一医院心内科 [4]安徽中医学院附属第一医院心内科

出　　处：《临床心血管病杂志》2005年第1期39-42,共4页Journal of Clinical Cardiology

基　　金：安徽省自然科学基金资助项目(No:03043710);安徽省优秀青年科研基金资助项目

摘　　要：目的:探讨急性前壁心肌梗死(MI)患者行直接经皮冠状动脉血运重建术(PCI)后心电图ST段持续 性抬高对MI后晚期左室功能和临床预后的影响。方法:选择因急性前壁MI入院成功接受直接PCI的患者72 例,动态观察PCI前后心电图ST段的变化,以PCI后1hST段下降>50%为ST段下降组,相反为ST段抬高 组。应用超声心动图测定MI后早期(2～3周)和晚期(5～6个月)左室功能和室壁活动异常的变化,并随访其间 心血管事件的发生率。结果:ST段下降组53例(73.6%),ST段抬高组19例(26.4%)。MI后早期两组间左室 功能和室壁活动异常(VWMA)无明显差异;晚期ST段抬高组左室射血分数(LVEF)明显低于ST段下降组(P <0.05),而左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)和VWMA积分均明显高 于ST段下降组(P<0.05,P<0.01)。随访期间ST段抬高组主要心血管事件的发生率略高于ST段下降组, 但差异无统计学意义。ST段下降组MI前心绞痛和直接支架术的比例明显高于ST段抬高组(P<0.05)。结 论:ST段持续性抬高者MI晚期左室功能较差,有MI前心绞痛和直接支架术者PCI后ST段持续性抬高的发生 率可能较低。Objective: To investigate the effect of persistent ST-segment elevation after successful direct percutanous coronary intervention (PCI) on the late phase left ventricular (LV) systolic function in acute anterior wall myocardial infarction. Method:Serial electrocardiograms were recorded before PCI and 1 hour after reperfusion in 72 patients with acute anterior wall myocardial infarction. The reduction of ST-segment elevation after successful PCI more than 50% was defined as ST-segment resolution (ST reduction group). Persistent ST-segment elevation was defined as ≥50% of peak ST elevation (ST elevation group). Echocardiography was performed on 2 to 3 weeks (early phase) and 5 to 6 months(late phase)after PCI to evaluate the LV function and ventricular wall motion abnormality (VWMA). Result:Fifty-three patients (74%) had early ST segment elevation resolution and 19 patients (26%) did not. The LV function and VWMA were similar in two groups during early phase. But during the late phase, ST elevation group patients had lower LVEF and higher LVEDVI, LVESVI, VWMA index compared with ST reduction group (P< 0.05, P< 0.01). Patients with angina before AMI and direct stenting during PCI were more common in ST reduction group (55% vs 26%, 32% vs 5%, P< 0.05). Conclusion: Persistent ST segment elevation shortly after successful direct PCI predicts poor late phase LV function in acute anterior wall myocardial infarction.

关 键 词：心肌梗死 经皮冠状动脉血运重建术 心电描记术 心室功能 左 

分 类 号：R542.2[医药卫生—心血管疾病]