急性前壁心梗经皮冠状动脉血运重建术后ST段持续抬高对心梗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 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 [2]滁洲市二院心内科 [3]合肥市一院心内科 [4]安徽中医学院附一院心内科

出　　处：《介入放射学杂志》2004年第S2期26-29,共4页Journal of Interventional Radiology

基　　金：安徽省自然科学基金项目 (编号 :0 3 0 43 710 );安徽省优秀青年科研基金资助

摘　　要：目的　探讨急性前壁心肌梗死行直接经皮冠状动脉血运重建术 (PCI)后心电图ST段持续抬高对心梗后晚期左室功能和临床预后的影响。方法　选择因急性前壁心肌梗死入院接受急诊PCI的患者 72例 ,动态观察PCI术前后心电图ST段的变化 ,以PCI术后 1hST段下降大于 5 0 %为ST段下降组 ,相反为ST段抬高组。应用超声心动图测定心梗后早期 (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 5 3例 (74 % ) ,ST段抬高组 19例(2 6 % )。心梗后早期两组间左室功能和室壁活动异常无明显差异 ;晚期ST段抬高组LVEF明显低于ST段下降组 (P <0 .0 5 ) ,而LVEDVI、LVESVI和VWMA积分均明显高于ST段下降组 (P <0 .0 5 ,P <0 .0 1)。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段下降组梗死前心绞痛和直接支架术的比例明显高于ST段抬高组 (P <0 .0 5 )。结论　急性前壁心肌梗死成功直接PCI后ST段持续性抬高者心梗后晚期左室功能较差。Objective To investigate the effect of persistent ST-segment elevation after successful direct percutanous coronary intervention (PCI) on the late phase of left ventricular (LV) systolic function in acute anterior wall myocardial infarction.Methods Serial electrocardiograms were record 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). Results 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).Conclusions Persistent ST segment elevation shortly after successful direct PCI predicts poor late phase LV function in acute anterior wall myocardial infarction.

关 键 词：急性心肌梗死 经皮冠状动脉血运重建术 心电图 左室功能 

分 类 号：R542.22[医药卫生—心血管疾病]