急诊冠状动脉介入治疗前自发性正常血流对急性心肌梗死预后的影响  

Impact of normal flow (TIMI-3) before coronary intervention therapy on the survival of patients suffering acute myocardial infarction

作　　者：李帮清[1] 胡大一[1] 卢明瑜[1] 吴淳[1] 徐成斌[1] 

机构地区：[1]北京大学人民医院心内科,北京100044

出　　处：《北京大学学报（医学版）》2007年第6期630-633,共4页Journal of Peking University:Health Sciences

摘　　要：目的：评价急诊介入治疗（percutaneous coronary intervention，PCI）前自发性正常血流[TIMI（thrombolysis in acute myocardial infarction，TIMI）3级]对急性心肌梗死患者PCI结果和预后的影响。方法：入选我院2000年到2006年连续就诊的301例诊断为ST段抬高型急性心肌梗死，并且在发病12h内行直接PCI的患者，随访1年，对住院期间的临床情况、30天死亡率及1年死亡率进行分析，并对随访资料进行生存分析。结果：在入选的301例急诊PCI患者中，初始造影显示有14．6％的患者有自发性的正常血流。与未达到血流TIMI-3级的患者比较，PCI前TIMI-3级血流的患者较少出现新发心力衰竭（2．3％vs16％，P=0．016）和心源性休克（0％vs8．6％，P=0．044），且其住院时间较短（P=0．008），30天死亡率较低（0％傩9．3％，P：0．035）。PCI前TIMI-3级血流的患者1年累计死亡率亦显著低于PCI前TIM10～2级血流的患者（0％vs11．3％，P=0．019）。但生存分析（COX回归分析）未发现PCI前TIMI-3级血流是生存的独立决定因子，却发现PCI后TIMI-3级血流为生存的独立决定因子（OR=0．285，P=0．004）。完全或部分缓解的症状和正在吸烟为PCI前TIMI-3级血流的独立影响因子（OR=2．610，P=0．005和OR=2．557，P=0．048）。结论：直接PCI前自发性TIMI-3级血流的患者在临床与冠状动脉造影方面表现出更大的挽救心肌的证据，较少发生左心衰竭相关的并发症，并且早期与晚期生存率高。Objective： To define impact of spontaneous TIMI-3 flow before angioplasty on outcomes of percutaneous coronary intervention strategy and the prognosis in patients with acute myocardial infarction （AMI）. Methods： The consecutive 301 patients enrolled in the ongoing register of emergent coronary angioplasty within 12 hours from symptoms who were diagnosed as having ST elevation AMI in our hospital from 2000 to 2006 were analyzed, they were followed up for one year and the clinical characteristics and survival rates were analysed. Results： Among the 301 patients enrolled in the ongoing register of emergent coronary angioplasty, spontaneous reperfusion （TIMI-3 flow） was present in 14.6% at initial angiography. Compared with patients without TIMI-3 flow, those with TIMI-3 flow before coronary intervention were less likely to present in new-onset heart failure（2.3% versus 16%, P =0. 016）, Patients with initial TIMI-3 flow had significantly lower 30-day mortality （0% versus 9.3%, P = 0. 035 ） , and cardiogenic shock （0% versus 8.6%, P = 0. 044） and had a shorter hospital stay （P = 0. 008）. Cumulative 1-year mortality was 0% in patients with initial TIMI-3 flow, 11.3% with TIMI 0-2 flow （P = 0.019）. By COX regression analysis, postprocendural TIMI-3 flow was an independent determinant of survival （OR =0.285 ,P =0. 004） , however,TIMI-3 flow before coronary intervention was not found as an independent determinant of survival significantly. The lenitive symptoms and current smoking were the independent determinants of TIMI-3 flow before coronary intervention （ P = 0. 005, P = 0. 048, respectively）. Conclusion： Patients undergoing primary percutaneous transluminal coronary intervention in whom TIMI-3 flow is present before angioplasty may present with greater clinical and angiographic evidence of myocardial salvage, be less likely to develop complications related to left ventricular failure, and improve early and late survival.

关 键 词：血管成形术 经腔 经皮冠状动脉 心肌梗死 无病生存 

分 类 号：R542.22[医药卫生—心血管疾病]