急性ST段抬高型心肌梗死自發再灌注患者的臨床及造影特點分析_《中國循證醫學雜志》

作者：

王健 ,  顏紅兵 , 鄭斌 , 程姝娟 , 王韶屏 , 張曉江 , 劉臣

首都醫科大學附屬北京安貞醫院（北京 100029）;

關鍵詞：

急性ST段抬高型心肌梗死自發再灌注

DOI：

10.7507/1672-2531.20120048

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目的　探討罪犯血管發生自發再灌注的急性ST段抬高型心肌梗死（STEMI）的臨床及造影特點。
方法　將2006年1月至2009年12月在安貞醫院28病房行直接經皮冠脈介入治療（PCI）的STEMI患者519例，根據直接PCI術前罪犯血管TIMI血流分級，把患者分為自發再灌注組（TIMI血流Ⅲ級）和無自發再灌注組（TIMI血流0～Ⅱ級）。通過冠脈造影觀察直接PCI前罪犯血管自發再灌注的發生率，并對其臨床相關因素及造影病變特點進行分析。
結果　兩組患者在年齡、CTnI峰值、≥ 2支血管病變高血栓負荷以及罪犯病變位于LAD部位方面的差異均有統計學意義（其P值分別為0.000、0.000、0.002、0.000和0.003）。而在性別、高血壓、糖尿病、吸煙、高脂血癥、既往心絞痛、罪犯血管分布、罪犯病變在LCX和RCA分布以及側枝循環建立方面，其差異均無統計學意義（P值均 gt;0.05）。
結論　與未發生自發再灌注的患者相比，自發再灌注的STEMI患者年齡較小，CTnI峰值較低，血栓負荷較重，罪犯病變多位于LAD遠段。

引用本文： 王健,顏紅兵,鄭斌,程姝娟,王韶屏,張曉江,劉臣. 急性ST段抬高型心肌梗死自發再灌注患者的臨床及造影特點分析. 中國循證醫學雜志, 2012, 12(3): 289-292. doi: 10.7507/1672-2531.20120048 復制

1.	Christian TF, Milavetz JJ, Miller TD, et al. Prevalence of spontaneous reperfusion and associated myocardial salvage in patients with acute myocardial infarction. Am Heart J, 1998, 135(3)：21-427.
2.	Taher T, Fu Y, Wagner GS, et al. Aborted myocardial infarction in patients with ST-segment elevation: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 Trial Electrocardiographic Substudy. J Am Coll Cardiol, 2004, 44(1): 38-43.
3.	The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med, 1997, 337(4): 1621-1628.
4.	Maseri A, LAbbate A, Baroldi G, et al. Coronary vasospasm as a possible cause of myocardial infarction: a conclusion derived from the study of preinfarct angina. N Engl J Med, 1978, 299(23): 1271-1277.
5.	Folts JD, Crowell EB Jr, Rowe GG. Platelet aggregation in partially obstructed vessels and its elimination with aspirin. Circulation, 1976, 54(3): 365-370.
6.	Rimar D, Crystal E, Battler A, et al. Improved prognosis of patient spresenting with clinical markers of spontaneous reperfusion during acute myocardial infarction. Heart, 2002, 88(4): 352-356.
7.	Stone GW, Cox D, Garcia E, et al. Normal flow (TIMI-3) before myocardial reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation, 2001, 104(6): 636-641.
8.	Ishihara M, Inoue I, Kawagoe T, et al. Impact of spontaneous anterograde flow of the infarct artery on left ventricular function in patients with first anterior wall myocardial infarction. Am J Cardiol, 2002, 90(1): 5-9.
9.	Haider AW, Andreotti F, Hackett DR, et al. Early spontaneous intermittent myocardial reperfusion during acute myocardial infarction is associated with augmented thrombogenic activity and less myocardial damage. J Am Coll Cardiol, 1995, 26(3): 662-667.
10.	Lee CW, Hong MK, Lee JH, et al. Determinants and prognostic significance of spontaneous coronary recanalization in acute myocardial infarction. Am J Cardiol, 2001, 87(8): 951-954.
11.	Harjai KJ, Mehta RH, Stone GW, et al. Does proximal location of culprit lesion confer worse prognosis in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction? J Interv Cardiol, 2006, 19(4): 285-294.
12.	Fefer P, Hod H, Hammerman H, et al. Relation of clinically defined spontaneous reperfusion to outcome in ST-elevation myocardial infarction. Am J Cardiol, 2009, 103(2): 149-153.
13.	Uriel N, Moravsky G, Blatt A, et al. Acute myocardial infarction with spontaneous reperfusion: clinical characteristics and optimal timing for revascularization. Isr Med Assoc J, 2007, 9(4): 243-246.
14.	Ruda MI, Kuzmin AI, Merkulova IN, et al. Spontaneous reperfusion of the infarct-related artery in patients with ST elevated myocardial infarction. Ter Arkh, 2009, 81(5): 20-29.
15.	Bainey KR, Fu Y, Granger CB, et al. Benefit of angiographic spontaneous reperfusion in STEMI: does it extend to diabetic patients? Heart, 2009, 95(16): 1331-1336.
16.	Kim JW, Seo HS, Suh SY, et al. Relationship between lipoprotein(a) and spontaneous recanalization of infarct-related arteries in the early phase of acute myocardial infarction. Clin Cardiol, 2008, 31(5): 211-216.

1. Christian TF, Milavetz JJ, Miller TD, et al. Prevalence of spontaneous reperfusion and associated myocardial salvage in patients with acute myocardial infarction. Am Heart J, 1998, 135(3)：21-427.
2. Taher T, Fu Y, Wagner GS, et al. Aborted myocardial infarction in patients with ST-segment elevation: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 Trial Electrocardiographic Substudy. J Am Coll Cardiol, 2004, 44(1): 38-43.
3. The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med, 1997, 337(4): 1621-1628.
4. Maseri A, LAbbate A, Baroldi G, et al. Coronary vasospasm as a possible cause of myocardial infarction: a conclusion derived from the study of preinfarct angina. N Engl J Med, 1978, 299(23): 1271-1277.
5. Folts JD, Crowell EB Jr, Rowe GG. Platelet aggregation in partially obstructed vessels and its elimination with aspirin. Circulation, 1976, 54(3): 365-370.
6. Rimar D, Crystal E, Battler A, et al. Improved prognosis of patient spresenting with clinical markers of spontaneous reperfusion during acute myocardial infarction. Heart, 2002, 88(4): 352-356.
7. Stone GW, Cox D, Garcia E, et al. Normal flow (TIMI-3) before myocardial reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation, 2001, 104(6): 636-641.
8. Ishihara M, Inoue I, Kawagoe T, et al. Impact of spontaneous anterograde flow of the infarct artery on left ventricular function in patients with first anterior wall myocardial infarction. Am J Cardiol, 2002, 90(1): 5-9.
9. Haider AW, Andreotti F, Hackett DR, et al. Early spontaneous intermittent myocardial reperfusion during acute myocardial infarction is associated with augmented thrombogenic activity and less myocardial damage. J Am Coll Cardiol, 1995, 26(3): 662-667.
10. Lee CW, Hong MK, Lee JH, et al. Determinants and prognostic significance of spontaneous coronary recanalization in acute myocardial infarction. Am J Cardiol, 2001, 87(8): 951-954.
11. Harjai KJ, Mehta RH, Stone GW, et al. Does proximal location of culprit lesion confer worse prognosis in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction? J Interv Cardiol, 2006, 19(4): 285-294.
12. Fefer P, Hod H, Hammerman H, et al. Relation of clinically defined spontaneous reperfusion to outcome in ST-elevation myocardial infarction. Am J Cardiol, 2009, 103(2): 149-153.
13. Uriel N, Moravsky G, Blatt A, et al. Acute myocardial infarction with spontaneous reperfusion: clinical characteristics and optimal timing for revascularization. Isr Med Assoc J, 2007, 9(4): 243-246.
14. Ruda MI, Kuzmin AI, Merkulova IN, et al. Spontaneous reperfusion of the infarct-related artery in patients with ST elevated myocardial infarction. Ter Arkh, 2009, 81(5): 20-29.
15. Bainey KR, Fu Y, Granger CB, et al. Benefit of angiographic spontaneous reperfusion in STEMI: does it extend to diabetic patients? Heart, 2009, 95(16): 1331-1336.
16. Kim JW, Seo HS, Suh SY, et al. Relationship between lipoprotein(a) and spontaneous recanalization of infarct-related arteries in the early phase of acute myocardial infarction. Clin Cardiol, 2008, 31(5): 211-216.

《中國循證醫學雜志》

急性ST段抬高型心肌梗死自發再灌注患者的臨床及造影特點分析

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《中國循證醫學雜志》

急性ST段抬高型心肌梗死自發再灌注患者的臨床及造影特點分析

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