首页|期刊导航|中华医学杂志（英文版）|Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion
Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion
PU Jun JIN Shu-xuan HE Ben SHAN Pei-ren DING Song QIAO Zhi-qin JIANG Li-sheng SONG Wei DU Yong-ping SHEN Jie-yan SHEN Lin-hong
中华医学杂志（英文版）2011，Vol.124Issue(6)：873-878,6.
中华医学杂志（英文版）2011，Vol.124Issue(6)：873-878,6.DOI:10.3760/cma.j.issn.0366-6999.2011.06.013
Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion
Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion
摘要
Abstract
Background Myocardial tissue-level perfusion failure is associated with adverse outcomes following ST-elevation myocardial infarction (STEMI) despite successful epicardial recanalization. We have developed a new quantitative index-thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC)-for assessing myocardial tissue level perfusion. However, factors affecting this novel index of myocardial perfusion are currently unknown.Methods A total of 255 consecutive STEMI patients undergoing primary angioplasty were enrolled. Myocardial tissue level perfusion was assessed by TMPFC, which measures the filling and clearance of contrast in the myocardium using cine-angiographic frame counting. We differentiate three groups with two cut off values for TMPFC: a TMPFC of 90frames was the upper boundary of the 95% confidence interval (CI) for the TMPFC observed in normal arteries, and a TMPFC of 130 was the 75th percentile of TMPFC.Results STEMI patients with TMPFC ＞130 frames (68 patients, 26.7%) had higher clinical and angiographic risk factor profiles as well as a higher 30-day MACE rate compared with those with TMPFC ≤90 frames and those with TMPFC ＞90and ≤130 frames. Multivariable analysis identified that the independent predictors of TMPFC ＞130 frames were age ≥75years (OR 2.08, 95% CI 1.21 to 3.58, P=0.007), diabetes (OR 1.37, 95% CI 1.01 to 1.86, P=0.042), Killip class ≥2 (OR1.52, 95% CI 1.05 to 2.21, P=0.027), and prolonged pain-to-balloon time (OR 1.73, 95% CI 1.07 to 2.79, P=0.013).TMPFC ＞130 frames was identified as the strongest independent predictor of 30-day major adverse cardiac event (MACE) (OR 2.77, 95% CI 1.21 to 6.31, P=0.008), along with age ≥75 years (OR 2.19, 95% CI 1.11 to 4.33, P=0.016),female gender (OR 1.67, 95% CI 1.03 to 2.70, P=0.038), and Killip class ≥2 (OR 1.83, 95% CI 1.07 to 3.14, P=0.021).Conclusions STEMI patients with poor myocardial perfusion assessed by TMPFC had higher risk factor profiles.Advanced age, diabetes, higher Killip class, and longer ischemia time were independent predictors of impaired TMPFC after primary percutaneous coronary intervention. These results emphasize that particular attention should be paid on myocardial microvascular reperfusion in STEMI patients with these risk factors.关键词
myocardial infarction/perfusion/angioplasty/outcomeKey words
myocardial infarction/perfusion/angioplasty/outcome引用本文复制引用
PU Jun,JIN Shu-xuan ,HE Ben ,SHAN Pei-ren,DING Song,QIAO Zhi-qin,JIANG Li-sheng,SONG Wei,DU Yong-ping,SHEN Jie-yan,SHEN Lin-hong..Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion[J].中华医学杂志（英文版）,2011,124(6):873-878,6.基金项目
This work was supported by the grants from the Program of Shanghai Subject Chief Scientist (No.35508XD14026),Shanghai Natural Science Foundation (No.09ZR1418100),and Shanghai Jiao Tong University Science and Technology Foundation (No.YZ1005). （No.35508XD14026）
