LATE REPERFUSION FOR ACUTE MYOCARDIAL-INFARCTION LIMITS THE DILATATION OF LEFT-VENTRICLE WITHOUT THE REDUCTION OF INFARCT SIZE
LATE REPERFUSION FOR ACUTE MYOCARDIAL-INFARCTION LIMITS THE DILATATION OF LEFT-VENTRICLE WITHOUT THE REDUCTION OF INFARCT SIZE
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DOI：
10.1161/01.cir.88.6.2565
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发表时间：
1993-12-01
期刊：
影响因子：
37.8
通讯作者：
KODAMA, K
中科院分区：
文献类型：
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作者：
HIRAYAMA, A;ADACHI, T;KODAMA, K
背景虽然以前的临床研究表明，在急性心肌梗死的相对晚期（“晚期再灌注”）进行再灌注可能对预防左心室扩大有有益作用，但其机制尚未阐明。在89例初始前壁心肌梗死患者中，69例再灌注成功。根据症状发作后达到再灌注所需的时间，将这69例患者分为三组：早期再灌注组（从发作到再灌注6小时; n=19）。20名梗死相关动脉在急性期和1个月后闭塞的患者被归类为未再灌注。在发病后1个月，通过Tl-201单光子发射计算机断层扫描评估的缺损体积，晚期再灌注组的CT大小为1593+/-652单位（平均值+/-SD），明显较大（发病后6小时）并不限制梗死面积或保留左心室功能。相反，舒张末期容积指数在早期再灌注组（50+/-15 mL/m2）、中期再灌注组（54+/-14 mL/m2）和晚期再灌注组（53+/-19 mL/m2）之间没有显著差异;这些显著小于非再灌注组（68+/-12 mL/m2; P
Background. While previous clinical studies have shown a possible beneficial effect of the reperfusion performed at a relatively late phase of acute myocardial infarction (''late reperfusion'') in preventing left ventricular enlargement, the mechanism has not been clarified.Methods and Results. Of 89 patients with an initial anterior myocardial infarction, reperfusion was successful in 69. These 69 were divided into three groups according to the time required to achieve reperfusion after the onset of symptoms: early-reperfused (6 hours from the onset to reperfusion; n=19). The 20 patients whose infarct-related artery were occluded in the acute phase as well as 1 month later was classified as nonreperfused. Infarct size, evaluated as defect volume by Tl-201 single-photon emission computed tomography 1 month after the onset, was 1593+/-652 units (mean+/-SD) in the late-reperfused group, significantly larger (P6 hours after onset) did not limit infarct size or preserve left ventricular function. In contrast, the end diastolic volume index did not differ significantly among the early-reperfused (50+/-15 mL/m(2)), intermediate-reperfused (54+/-14 mL/m(2)), and late-reperfused (53+/-19 mL/m(2)) groups; those were significantly smaller than that of the nonreperfused group (68+/-12 mL/m(2); P