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目的:探讨急性ST段抬高性前壁心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)即刻前向心肌梗死溶栓治疗临床试验(TIMI)3级血流患者左心室功能不全的相关因素。方法:分析我院2004-01至2009-01的273例急诊PCI患者的临床和冠状动脉造影资料,STEMI直接PCI即刻前向血流TIMI3级心功能不全患者52例,为心功能不全组,由其余前壁STEMI直接PCI即刻前向血流TIMI3级心功能正常的患者中随机抽取60例,为心功能正常组,运用logistic回归分析左心室功能不全的相关因素。结果:STEMI直接PCI即刻前向血流TIMI3级心功能不全的发生率为19%。心功能不全组与心功能正常组比较,糖尿病、症状开始至再灌注的时间、梗死前心绞痛、心肌灌注显影血流分级(TMBG),室壁运动积分(WMS),室壁运动积分指数(WMSI)差异有统计学意义(P<0.05～0.001)。Logistic多元回归分析表明:梗死前心绞痛、心肌灌注显影血流分级,室壁运动积分和室壁运动积分指数与STEMI直接PCI即刻前向血流TIMI3级患者左心室功能不全相关(P<0.05)。结论:STEMI直接PCI即刻前向血流恢复TIMI3级,心肌灌注显影血流分级、微血管损伤和室壁运动异常可能会促使左心室功能不全的形成;梗死前心绞痛有助于微循环血流增加,可能减少左心室功能不全的发生;而冠心病的危险因素与左心室功能不全没有相关性。
Objective: To investigate the correlation between left ventricular (LV) ventricular dysfunction in patients with stage III thrombolysis clinical trial (TIMI) immediately before acute percutaneous transluminal coronary intervention (PCI) of acute ST elevation myocardial infarction (STEMI) factor. Methods: The clinical and coronary angiographic data of 273 patients with acute PCI from January 2004 to January 2009 in our hospital were analyzed. Among them, 52 patients with TIMI3 grade cardiac insufficiency immediately after STEMI direct PCI were heart failure patients, The remaining anterior wall STEMI direct PCI immediately prior to the flow of TIMI3-class patients with normal cardiac function were randomly selected 60 cases of normal cardiac function, the use of logistic regression analysis of left ventricular dysfunction related factors. RESULTS: The immediate incidence of TIMI3 grade cardiac insufficiency in STEMI direct PCI was 19%. Cardiac dysfunction group and normal cardiac function group, diabetes mellitus, the time from onset of symptom to reperfusion, pre-infarction angina, myocardial perfusion developed TMBG, wall motion integral (WMS), wall motion integral index (WMSI ) Difference was statistically significant (P <0.05 ~ 0.001). Logistic multivariate regression analysis showed that pre-infarction angina, perfusion myocardial perfusion imaging, wall motion integral and wall motion integral index were correlated with left ventricular dysfunction in STEMI immediate PCI TIMI3 patients (P <0.05). CONCLUSIONS: TIMI3 level is restored immediately by direct pre-PCI in STEMI, myocardial perfusion and development of blood flow classification, microvascular damage and abnormal wall motion may promote the formation of left ventricular dysfunction. Pre-infarction angina contributes to increased microcirculation blood flow, possibly Reduce the incidence of left ventricular dysfunction; and coronary heart disease risk factors and left ventricular dysfunction is not related.