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2018, vol. 57, br. 2, str. 92-100
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Brzina koronarnog protoka CTFC može predvideti remodelovanje leve komore posle infarkta miokarda kod bolesnika sa TIMI 3 protokom nakon primarne perkutane koronarne intervencije na proksimalnom segmentu prednje descedentne arterije
Angiographic corrected TIMI frame Count Can predict left ventricular remodeling after acute anterior myocardial infarction in patients with TIMI 3 flow immediately after primary PCI on proximal left anterior descending coronary artery
aKlinički centar Niš, Klinika za kardiovaskularne bolesti + Univerzitet u Nišu, Medicinski fakultet bKlinički centar Niš, Klinika za kardiovaskularne bolesti
e-adresa: milanpa@eunet.rs
Sažetak
Cilj ispitivanja bio je da se proceni brzina koronarnog protoka u prednjoj descedentnoj arteriji LAD neposredno nakon primarne perkutane koronarne intervencije kod bolesnika sa akutnim infarktom prednjeg zida, korišćenjem korigovanog broja angiografskih slika CTFC, i da se brzina protoka u infarktnoj arteriji uporedi sa rezolucijom elevacije ST segmenta elektrokardiograma, ehokardiografskim parametrima funkcije leve komore i sa kliničkim ishodom u toku hospitalizacije i nakon 12 meseci. U ispitivanje je uključeno devedeset osam bolesnika sa uspešnom mehaničkom reperfuzijom miokarda, koji su postigli TIMI 3 protok u infarktnoj arteriji i koji nisu bili planirani za dalju revaskularizaciju miokarda, od ukupno 156 konsekutivnih bolesnika sa prvim infarktom prednjeg zida. U grupi sa bržim TIMI 3 protokom (CTFC ≤ 27) bilo je 44 bolesnika, od kojih je 14 imalo intervenciju na proksimalnom segmentu LAD, 16 na medijalnom i 14 na distalnom segmentu LAD. U grupi sa sporijim TIMI 3 protokom (CTFC 28-40) bilo je 54 bolesnika, od kojih je 18 imalo intervenciju na proksimalnom segmentu LAD, 22 na medijalnom i 14 na distalnom segmentu LAD. Bolesnici sa primarnom PCI na proksimalnom segmentu LAD i bržim TIMI 3 protokom (CTFC ≤ 27) značajno su češće (50%) postigli kompletnu rezoluciju ST segmenta elektrokardiograma, 90 minuta nakon PCI, u poređenju sa bolesnicima sa PCI na proksimalnom segmentu LAD i sporijim TIMI 3 (CTFC 28-40) protokom (17%, p < 0,025). Bolesnici sa PCI na proksimalnom segmentu LAD i bržim TIMI 3 protokom (CTFC ≤ 27) su nakon 12 meseci imali značajno manji ehokardiografski endosistolni volumen indeks (ESVI) 31,3 ± 6,7 ml/m2, u poređenju sa bolesnicima sa PCI na proksimalnom segmentu LAD i sporijim TIMI 3 protokom 37,2 ± 6,5 ml/m2 (p < 0,025). Brži TIMI 3 protok u infarktnoj arteriji, nakon primarne PCI, bio je udružen sa češćim postizanjem kompletne rezolucije ST segmenta elektrokardiograma u akutnoj fazi, i sa manje ispoljenim remodelovanjem leve komore nakon 12 meseci, samo ukoliko je infarktna koronarna lezija bila lokalizovana na proksimalnom segmentu LAD.
Abstract
The aim of this study was to evaluate coronary flow in the LAD coronary artery immediately after primary PCI in patients with acute anterior myocardial infarction, using the quantitative Corrected TIMI Frame Count (CTFC) method, and to compare coronary flow velocity with ST segment elevation resolution of electrocardiogram, echocardiographic left ventricular function parameters, and clinical outcomes during hospitalisation and after 12 months. Ninety eight patients with successful mechanical myocardial reperfusion, who achieved TIMI 3 flow and who were not planned for further revascularisaton, out of 156 consecutive patients with first anterior myocardial infarction, were included in this study. There were 44 patients in the group with faster TIMI 3 flow (CTFC ≤ 27), of whom 14 had PCI on the proximal segment LAD artery, 16 on medial and 14 on distal segment, and 54 patients in the group with slower TIMI 3 flow (CTFC 28-40) of whom 18 patients had intervention on proximal segment LAD artery, 22 on medial and 14 on distal segment. The patients with primary PCI on proximal LAD segment with faster TIMI 3 flow achieved significantly more often complete ST segment elevation resolution at 90 minutes after PCI (50%), compared to those with slower TIMI 3 flow (17%, p < 0.025). The patients with PCI on proximal LAD artery segment who had faster TIMI 3 flow, showed after 12 months a significantly lower echocardiographic end-systolic volume index (ESVI) 31.3 ± 6.7 ml/m2, compared to those with intervention on the proximal LAD coronary with slower TIMI 3 flow 37.2 ± 6.5 ml/m2 (p < 0.025). Faster TIMI 3 flow in the infarction artery was accompanied with a more complete ST segment resolution in acute phase and lesser left ventricular remodeling after 12 months, only if the culprit lesion was localized in the proximal LAD artery segment.
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