Table II. Correlation between ST resolution and CTFCª
ST resolution
CTFC slow
group
(n = 24)
P
CTFC fast group (n = 39)
Complete resolution (%) Partial resolution (%) No resolution (% )
6/24 (25.0)*
11/24 (45.8)
7/24 (29.2)*
0.0040 0.4243 0.0037
25/39 (54.1) 13/39 (33.3)
1/39 (2.6)
* The CTFC fast group had a higher ratio of complete ST resolution than the CTFC slow group and lower ratio of no ST resolution than the CTFC slow group.
Compared with CTFC fast group *P < 0.05.
The Relationship Between ∆WMSI and CTFC
There was no significant difference in WMSI between the two groups before PCI. One month after PC the WMSI improved significantly in both groups, but the change in WMSI (∆WMSI) in the CTFC fast group was significantly larger than that of the CTFC slow group (1.30 ± 0.41 vs. 0.64 ± 0.30, P < 0.05) see Fig.). The relationship between ∆WMSI and CTFC is presented in Figure 2. There was a significant negative correlation between ∆WMSI and CTFC (r = −0.75, P < 0.01).
DISCUSSION
The major finding of the present study is that among patients with ST-segment elevation AMI successfully treated by successful primary PCI, CTFC combined
with electrocardiogram ST-segment resolution could give additional prognostic information and provide evidence for additional adjunctive treatment.
The goal of reperfusion therapy for acute myocardial infarction is to re-establish the flow of nutritive, oxygenated blood to myocytes quickly, Correlations between sustained patency of the IRA and improved clinical outcomes culminated in the "open-artery hypothesis." Re-establishing a patent IRA with normal anterograde flow salvages stunned myocardial tissue, preserves left ventricular mechanical function, and positively influences clinical outcomes. Approximately 25% to 30% of patients with restoration of normal anterograde flow in the epicardial IRA, however, do not have reperfusion of the myocardium at the tissue level. As we all know, the goal of reperfusion therapy should he to restore not only epicardial patency and flow, but also myocardial tissue perfusion [5].
How to evaluate microcirculatory flow has become the important point. The TIMI flow grading system is used to assess coronary blood flow after revascularization. But this qualitative, categorical grading scheme is subjective and lacks reproducibility. Myocardial contrast echocardiography (MCE), radionuclide techniques, single-photon emission tomographic (SPET) imaging, and Doppler guide wire intracoronary could be used lo evaluate myocardial tissue perfusion, but these examinations involve high cost, high technique and are time consuming, which render them unfit for clinical utilization [6]. CTFC is relatively objective, easy, economical, and reproducible to estimate perfusion of myocytes level [7]. CTFC may add additional prognostic information within TIMI grade 3 flow and permit risk stratification [8,9].
The most commonly used method to assess myocardial reperfusion has been the monitoring of ST-segment resolution at different time points after reperfusion therapy. Evaluating ST-segment resolution with serial electrocardiogram was first recommended as a useful bedside marker of reperfusion success by Braunwald and Maroko 30 years ago and could contribute to decide the exact reperfusion time [10]. The degree of
Fig. 1. Bar graph showing the change in wall motion score index from admission to 1 month after PCI in the two groups. One month after PCI, the improvement in wall motion score Index (∆WMSI) in the CTFC fast group was significantly larger than that of the CTFC slow group (*P < 0.05).
Fig. 2. Linear graph showing the correlation between ∆WMSI and CTFC. There was a significant negative correlation between ∆WMSI and CTFC (r = -0.75, P < 0.01).
ST resolution
CTFC slow
group
(n = 24)
P
CTFC fast group (n = 39)
Complete resolution (%) Partial resolution (%) No resolution (% )
6/24 (25.0)*
11/24 (45.8)
7/24 (29.2)*
0.0040 0.4243 0.0037
25/39 (54.1) 13/39 (33.3)
1/39 (2.6)
* The CTFC fast group had a higher ratio of complete ST resolution than the CTFC slow group and lower ratio of no ST resolution than the CTFC slow group.
Compared with CTFC fast group *P < 0.05.
The Relationship Between ∆WMSI and CTFC
There was no significant difference in WMSI between the two groups before PCI. One month after PC the WMSI improved significantly in both groups, but the change in WMSI (∆WMSI) in the CTFC fast group was significantly larger than that of the CTFC slow group (1.30 ± 0.41 vs. 0.64 ± 0.30, P < 0.05) see Fig.). The relationship between ∆WMSI and CTFC is presented in Figure 2. There was a significant negative correlation between ∆WMSI and CTFC (r = −0.75, P < 0.01).
DISCUSSION
The major finding of the present study is that among patients with ST-segment elevation AMI successfully treated by successful primary PCI, CTFC combined
with electrocardiogram ST-segment resolution could give additional prognostic information and provide evidence for additional adjunctive treatment.
The goal of reperfusion therapy for acute myocardial infarction is to re-establish the flow of nutritive, oxygenated blood to myocytes quickly, Correlations between sustained patency of the IRA and improved clinical outcomes culminated in the "open-artery hypothesis." Re-establishing a patent IRA with normal anterograde flow salvages stunned myocardial tissue, preserves left ventricular mechanical function, and positively influences clinical outcomes. Approximately 25% to 30% of patients with restoration of normal anterograde flow in the epicardial IRA, however, do not have reperfusion of the myocardium at the tissue level. As we all know, the goal of reperfusion therapy should he to restore not only epicardial patency and flow, but also myocardial tissue perfusion [5].
How to evaluate microcirculatory flow has become the important point. The TIMI flow grading system is used to assess coronary blood flow after revascularization. But this qualitative, categorical grading scheme is subjective and lacks reproducibility. Myocardial contrast echocardiography (MCE), radionuclide techniques, single-photon emission tomographic (SPET) imaging, and Doppler guide wire intracoronary could be used lo evaluate myocardial tissue perfusion, but these examinations involve high cost, high technique and are time consuming, which render them unfit for clinical utilization [6]. CTFC is relatively objective, easy, economical, and reproducible to estimate perfusion of myocytes level [7]. CTFC may add additional prognostic information within TIMI grade 3 flow and permit risk stratification [8,9].
The most commonly used method to assess myocardial reperfusion has been the monitoring of ST-segment resolution at different time points after reperfusion therapy. Evaluating ST-segment resolution with serial electrocardiogram was first recommended as a useful bedside marker of reperfusion success by Braunwald and Maroko 30 years ago and could contribute to decide the exact reperfusion time [10]. The degree of
Fig. 1. Bar graph showing the change in wall motion score index from admission to 1 month after PCI in the two groups. One month after PCI, the improvement in wall motion score Index (∆WMSI) in the CTFC fast group was significantly larger than that of the CTFC slow group (*P < 0.05).
Fig. 2. Linear graph showing the correlation between ∆WMSI and CTFC. There was a significant negative correlation between ∆WMSI and CTFC (r = -0.75, P < 0.01).
No hay comentarios:
Publicar un comentario