再灌注治疗的ST段抬高型心肌梗死(STEMI)

摘要/Abstract

摘要： ST段抬高心肌梗死(STEMI)是一个主要的健康问题, 甚至在目前急性心肌梗死的诊断和管理不断改善中也如此。STEMI在大约33％的患者中发生致命事件。 STEMI是唯一的第二位最严重的急性冠脉综合征(ACS)的后心源性猝死的形式。约29％心肌梗死的患者经历过STEMI(1), 而47％的急性冠脉综合征(ACS)患者, 表现出STEMI(2)症状。 STEM是冠心病三要素之一, 其他两个分别是不稳定型心绞痛和非ST段抬高心肌梗死(NSTEMI), 三者构成已知冠心病要素。急性冠脉综合征的特点是急性缺血性胸痛(休息痛或劳累痛)与缺血性心电图变化(ST段抬高或压低或T反转)联系在一起。有无ST段抬高是STEMI区别于急性冠心病其他形式的特征。 NSTEMI和不稳定型心绞痛以有无心肌损伤标记物的上升加以区别^[3-6。纤溶和经皮冠状动脉介入治疗(PCI), 最终在STEMI再灌注治疗。这些疗法已上一线, 改善梗死动脉通畅性, 减少梗死面积, 降低死亡率。时间敏感性STEMI要求一个或这两个疗法的快速实施^[4-7。调查表明, 许多西方国家STEMI病人很难接触再灌注治疗法, 而选择了临床使用成熟的药物疗法, 至今仍是未处理疗法。高达三分之一的STEMI患者在症状出现12小时内仍没有接受再紧急灌注治疗, 尽管保健在改善^[7-8, 但最近的一项研究显示, 80.9％, 在北京的STEMI患者接受再灌注治疗(81％为初始PCI;19％, 溶栓)。同时, 研究表明初始PCI是北京病人的主要再灌注疗法^[9。本文旨在给出两个明确的STEMI再灌注疗法的重要细节。

关键词: ST段抬高型心肌梗死, 再灌注治疗, 经皮冠状动脉介入

Abstract: ST segment elevation myocardial infarction (STEMI) is a major health concern even with the current improvements in diagnosing and managing acute MI.STEMI is still a fatal event in approximately 33% of patients.STEMI is only the second most severe form of acute coronary syndrome (ACS) after sudden cardiac death.About 29% of patients with myocardial infarction experience a STEMI (1),whereas 47% of acute coronary syndrome (ACS) patients present with STEMI (2).STEMI is one of the three components which constitute a spectrum of conditions known as acute coronary syndrome (ACS),the other two being unstable angina and Non-ST segment elevation myocardial infarction (NSTEMI).Acute coronary syndrome is characterized by a specific pattern of acute ischemic chest pain (either rest pain or minimal exertion),associated with ECG changes of ischemia (ST elevation or depression or T inversion).The presence of persistent ST elevation distinguishes STEMI from other forms of acute coronary syndrome.NSTEMI and unstable angina are distinguished by the presence or absence of a rise in cardiac injury markers^[3-6].Fibrinolysis and percutaneous coronary intervention (PCI),are the definitive therapies for reperfusion in STEMI.These strategies have been on a frontline to improve patency of the infarct-related artery,reduce infarct size,and lower mortality rates.The time sensitivity nature of STEMI prompts for a quick implementation of one or the other of these two strategies^[4-7].Surveys showed that many patients with STEMI from western countries remain “untreated” with limited access to reperfusion therapy and suboptimal utilization of proven pharmacotherapies in clinical practices.Up to one-third of patients presenting with STEMI within 12 h of symptom onset still receive no reperfusion therapy acutely,despite improvements in care^[7-8].However,a recent study has shown that,80.9% of patients with STEMI in Beijing received reperfusion treatment (81% primary PCI; 19% thrombolysis).Meanwhile,the study implies that primary PCI was the predominant reperfusion strategy in Beijing^[9].

Key words: ST-segment elevation myocardial infarction, Reperfusion treatment, Percutaneous coronary intervention

中图分类号:

R654.2

乔果(综述), 徐亚伟(审校). 再灌注治疗的ST段抬高型心肌梗死(STEMI)[J]. 外科研究与新技术, 2012, 1(1): 76-80.

Jongo S.A, Xu Ya-Wei. ST-segment elevation myocardial infarction; reperfusion treatment; percutaneous coronary intervention[J]. 外科研究与新技术, 2012, 1(1): 76-80.

参考文献

[1] Lloyd-Jones D,Adams R,Carnethon M,et al.Heart disease and stroke statistics—2009 update:a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee[J].Circulation,2009,119(3):e21-181.
[2] Mandelzweig L,Battler A,Boyko V,et al.The second Euro Heart Survey on acute coronary syndromes:characteristics,treatment,and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004[J].Eur Heart J,2006,27(19):2285-2293.
[3] KristianThygesen,Joseph S.Alpert,Harvey D.White.Universal Definition of Myocardial Infarction[J].J Am Coll Cardiol,2007,50(22):2173-2195
[4] Marc Cohen,Catalin Boiangiu,and Mateen Abidi.Therapy for ST-Segment Elevation Myocardial Infarction Patients Who Present Late or Are Ineligible for Reperfusion Therapy[J].Who J Am Coll Cardiol,2010,55(18):1895-1906.
[5] Boyle AJ,Jaffe AS.Acute myocardial infarction.In:Crawford MH,ed.CURRENT Diagnosis & Treatment-Cardiology.3rd Ed[M].The McGraw-Hill Companies,Inc,2009.51-64.
[6] GRECH ED.Percutaneous coronary intervention Ⅱ.The procedure.In:GRECH ED,ed.ABC OF INTERVENTIONAL CARDIOLOGY[M].London:BMJ Publishing Group Ltd,2005.8-10.
[7] Boden WE,MD,FACC,et al.Reperfusion Strategies in Acute ST-Segment Elevation Myocardial Infarction[J].J Am Coll Cardiol,2007,50(10):917-929.
[8] Antman EM,Anbe DT,et al.“ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction-executive summary:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction).”[J].Circulation,2004,110(5):588-636.
[9] Shou -Yan Zhang,Da -Yi Hu,Yi -Hong Sun,Jin- Gang Yang.Current management of patients with ST elevation myocardial infarction in Metropolitan Beijing,China[J].Clin Invest Med,2008,31(4):E189-E197.
[10] Kevin J.Woollard and Frederic Geissmann.Monocytes in atherosclerosis:subsets and functions[J].Nat Rev Cardiol,2010,7(2):77.
[11] Kosuge M,Kimura K,Ishikawa T,et al.Differences between men and women in terms of clinical features of ST-segment elevation acute myocardial infarction[J].Circ J,2006,70(3):222-226.
[12] Kyaw Thu Moe,Philip Wong.Current Trends in Diagnostic Biomarkers of Acute Coronary Syndrome[J].Ann Acad Med Singapore,2010,39(3):210-215.
[13] Bhatia L,BSc MRCP,Clesham GJ,et al.Clinical implications of ST-segment non-resolution after thrombolysis for myocardial infarction[J].J R Soc Med,2004,97(12):566-570.
[14] van der Zwaan HB,Stoel MG,Roos-Hesselink JW,et al.Early versus late ST-segment resolution and clinical outcomes after percutaneous coronary intervention for acute myocardial infarction[J].Neth Heart J,2010,18(9):416-422.
[15] Sejersten M,Valeur N,Grande P,et al.DANAMI-2 Investigators.Long-term prognostic value of ST-segment resolution in patients treated with fibrinolysis or primary percutaneous coronary intervention results from the DANAMI-2 (DANish trial in acute myocardial infarction-2)[J].J Am CollCardiol,2009,54(19):1763-1769.
[16] Poloczek M,Kala P,Neugebauer P,et al.ST-segment resolution as a simple tool for the assessment of successful primary coronary intervention at a microvascular level[J].VnitrLek,2004,50(10):740-745.
[17] Amit Kumar MD,Christopher P.Cannon,MD.Acute Coronary Syndromes:Diagnosis and Management,Part Ⅱ.Mayo Clin Proc,2009,84(11):1021-1036.
[18] Fukui T,Takanashi S.Indications for coronary artery bypass grafting in the DES era[J].Nihon Rinsho,2011,69(2):259-264.Review.