Myocardial perfusion grade after late infarct artery recanalization is associated with global and regional left ventricular function at one year: analysis from the Total Occlusion Study of Canada-2.
Myocardial perfusion grade after late infarct artery recanalization is associated with global and regional left ventricular function at one year: analysis from the Total Occlusion Study of Canada-2.
复制标题
晚期梗死动脉再通后的心肌灌注等级与一年时的整体和区域左心室功能相关：来自 Canada-2 完全闭塞研究的分析。
DOI：
10.1161/circinterventions.109.918722
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Dzavik,Vladimir
中科院分区：
文献类型：
--
作者：
Steigen,TerjeK;Buller,ChristopherE;Mancini,GBJohn;Jorapur,Vinod;Cantor,WarrenJ;Rankin,JamesM;Thomas,Boban;Webb,JohnG;Kronsberg,ShariS;Atchison,DeborahJ;Lamas,GervasioA;Hochman,JudithS;Dzavik,Vladimir
Backgroundwhether心肌灌注分级（MPG）后，梗死相关动脉（IRAs）的晚期再通预测左心室（LV）功能恢复超过急性期心肌梗死（MI）是unknown.Methods and ResultsThe Total Occlusion Study of Canada-2招募稳定的患者与持续闭塞的伊拉超过24小时，长达28天后MI。我们研究了139例经皮冠状动脉介入治疗（PCI）后3级心外膜血流溶栓的心肌梗死患者的初始MPG与左室功能和容积变化之间的关系，以及从PCI后即刻到1年的MPG变化，并将配对值分为MPG受损或良好MPG组（MPG 0/1或MPG 2/3）。MPG 0/1患者更可能接受过溶栓治疗，并有左前降伊拉。基线时，他们的血压和左室射血分数（LVEF）较低，心率和收缩球度指数较高。MPG 0/1和MPG 2/3组从基线至1年的变化分别为LVEF，3.3±9.0%和4.8±8.9%（P=0.42）;左心室收缩末期容积指数（LVESVI），−1.1±9.2和−4.7±12.3 mL/m2（P=0.25）;左心室舒张末期容积指数（LVEDVI），0.08±19.1和−2.4±22.2 mL/m2（P=0.67）;梗死区室壁运动指数（MI）的SD/弦，0.38±0.70和0.84±1.11（P=0.01）。经协变量校正分析，PCI术后MPG 0/1预测1年时较低的LVEF（P<0.001）、较低的LVEF（P<0.001）和较高的LVESVI（P<0.01），但不预测LVEDVI。MPG 0/1的患者，60%的MPG 2或3在1 year.ConclusionsPreserved MPG是目前在一个高比例的患者闭塞IRA后MI晚期PCI。PCI术后MPG较差通常可在1年内改善MPG。MI后数天至数周进行伊拉再通后的MPG分级与LV恢复相关，表明在亚急性MI后期间测定的MPG仍然是存活力的标志物。临床试验注册URL：http://www.clinicaltrials.gov。唯一标识符：NCT 00025766。
BackgroundWhether myocardial perfusion grade (MPG) following late recanalization of infarct-related arteries (IRAs) predicts left ventricular (LV) function recovery beyond the acute phase of myocardial infarction (MI) is unknown.Methods and ResultsThe Total Occlusion Study of Canada-2 enrolled stable patients with a persistently occluded IRA beyond 24 hours and up to 28 days post-MI. We studied the relationship between the initial MPG and changes in LV function and volume as well as the change in MPG from immediate post-percutaneous coronary intervention (PCI) to 1 year in 139 PCI patients with thrombolysis in myocardial infarction grade 3 epicardial flow post-PCI and with paired values grouped into impaired or good MPG groups (MPG 0/1 or MPG 2/3). MPG 0/1 patients were more likely to have received thrombolytic therapy and to have a left anterior descending IRA. They had lower blood pressure and LV ejection fraction (LVEF) and a higher heart rate and systolic sphericity index at baseline. Changes in the MPG 0/1 and MPG 2/3 groups from baseline to 1 year were LVEF, 3.3±9.0% and 4.8±8.9% (P=0.42); LV end-systolic volume index (LVESVI), −1.1±9.2 and −4.7±12.3 mL/m2(P=0.25); LV end-diastolic volume index (LVEDVI), 0.08±19.1 and −2.4±22.2 mL/m2(P=0.67); and SDs/chord for infarct zone wall motion index (WMI), 0.38±0.70 and 0.84±1.11 (P=0.01). By covariate-adjusted analysis, post-PCI MPG 0/1 predicted lower WMI (P<0.001), lower LVEF (P<0.001), and higher LVESVI (P<0.01) but not LVEDVI at 1 year. Of the MPG 0/1 patients, 60% were MPG 2 or 3 at 1 year.ConclusionsPreserved MPG is present in a high proportion of patients following late PCI of occluded IRAs post-MI. Poor MPG post-PCI frequently improves MPG over 1 year. MPG graded after IRA recanalization undertaken days to weeks post MI is associated with LV recovery, indicating that MPG determined in the subacute post-MI period remains a marker of viability.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00025766.