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目的联合应用TIMI心肌灌注分级(TMP)、心电图ST段抬高总和回落百分比(sumSTR)评价急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)后心肌灌注程度,探讨其对2年预后的预测价值。方法77例连续AMI患者急诊PCI后,即刻联合应用TMP与sumSTR方法评价心肌灌注程度;随访术后2年内死亡、再梗死、再次血运重建、心绞痛、心力衰竭事件;超声心动图测定术后72h、2年时左心室舒张末期内径(LVEDD)及射血分数(LVEF)。结果Cox多因素分析显示TMP分级为0~1级合并sumSTR<30%为PCI术后2年心脏事件的独立危险因子(RR=13·186,95%可信区间2·149~80·917,P=0·005);心肌灌注不良组术后2年LVEDD增大值(7·1mm±1·9mm)大于心肌灌注良好组(1·5mm±1·2mm)(t=15·777,P<0·01);卡方检验显示TMP与sumSTR方法联合应用的评价结果与PCI术后2年心功能水平密切相关(χ2=50·58,P<0·01)。结论TMP与sumSTR联合应用对AMI患者行急诊PCI术后2年的心脏事件和心功能有一定的预测价值。
Objective To evaluate the myocardial perfusion in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) by using TIMI myocardial perfusion grading (TMP) and sum ST electrocardiogram (sumSTR) The prognostic value of the year. Methods Twenty-seven consecutive AMI patients underwent emergency PCI immediately after PCI. TMP and sumSTR methods were used to evaluate the degree of myocardial perfusion; death, re-infarction, revascularization, angina pectoris and heart failure events were observed within 2 years after follow-up. , Left ventricular end-diastolic diameter (LVEDD) and ejection fraction (LVEF) at 2 years. Results Cox multivariate analysis showed that TMP grading of 0 to 1 grade with sumSTR <30% was an independent risk factor for 2-year cardiac events after PCI (RR = 13.186, 95% confidence interval 2.199-80.917, P = 0.005). The increase of LVEDD (7 · 1 mm ± 1 · 9 mm) in the myocardial perfusion group at 2 years after myocardial perfusion was larger than that in the myocardial perfusion group (1.5 · 5 ± 1.2 mm) (t = 15.777, P <0. 01). The chi-square test showed that the combination of TMP and sumSTR was closely related to the 2-year cardiac function after PCI (χ2 = 50.58, P <0.01). Conclusion Combined use of TMP and sumSTR can predict cardiac events and cardiac function in AMI patients 2 years after emergency PCI.