OBJECTIVE:To study the influence of clinical and angiographic factors on global and regional left ventricular (LV) function after rescue percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). METHODS:We performed repeat cardiac catheterization in 102 patients who underwent rescue PCI at our centre. Eighty-two patients had suitable baseline and follow-up ventriculograms, which were analyzed offline by an automated edge detection technique. RESULTS:The mean (standard deviation [SD]) follow-up period was 22 (15) months. PCI was completed in all patients between 3 to 24 hours following the onset of pain. Improved global and regional LV systolic function was observed in 55 (67%) patients, and deterioration in 27 (33%). On univariate analysis, baseline ejection fraction (p = 0.005) and coronary stenting (p = 0.05) were associated with improved LV systolic function. Preprocedure TIMI flow, postprocedure TMP grade, time-to-reperfusion, and use of glycoprotein (GP) IIb/IIIa inhibitors did not influence LV systolic function. On multivariate analysis, ejection fraction at the time of rescue PCI (odds ratio [95% confidence interval]: 0.427 [0.234, 0.780]; p = 0.006) and stenting 3.944 (1.182, 13.156; p = 0.026) were predictors of improved LV systolic function. CONCLUSION:Successful rescue PCI was associated with improved LV function at follow up in the majority of patients. Stenting, but not GP IIb/IIIa inhibitor therapy, predicted improved LV function in the area supplied by the infarct-related artery. These improvements in regional wall motion were independent of the time taken to establish reperfusion, provided the intervention was carried out between 3 to 24 hours from the onset of pain.

译文

目的:探讨急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗(PCI)后临床和血管造影因素对整体和区域左心室(LV)功能的影响。
方法:我们对102名在我们中心接受了急诊PCI的患者进行了重复心脏导管插入术。八十二例患者有合适的基线和心室图,并通过自动边缘检测技术对其进行了离线分析。
结果:平均随访时间(标准差[SD])为22(15)个月。疼痛发作后3至24小时内,所有患者均完成PCI。 55例(67%)患者的整体和区域左室收缩功能得到改善,而27例(33%)患者恶化。单因素分析显示,基线射血分数(p = 0.005)和冠状动脉支架置入术(p = 0.05)与左室收缩功能改善有关。术前TIMI流量,术后TMP分级,再灌注时间以及糖蛋白(GP)IIb / IIIa抑制剂的使用均不影响LV收缩功能。在多变量分析中,抢救PCI时的射血分数(几率[95%置信区间]:0.427 [0.234,0.780]; p = 0.006)和支架置入3.944(1.182,13.156; p = 0.026)是LV改善的预测指标收缩功能。
结论:大多数患者随访中成功的抢救性PCI与左室功能改善有关。支架术(但不是GP IIb / IIIa抑制剂疗法)预示着梗死相关动脉所供应区域的LV功能会改善。这些区域壁运动的改善与建立再灌注所需的时间无关,只要在疼痛发作后的3至24小时内进行干预即可。

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