Effects Of Myocardial Perfusion On The Heart Function And Prognosis Of STEMI After Emergency PCI

Objective Acute ST-segment elevation myocardial infarction (STEMI) of coronary heart disease (CHD) may cause severe myocardial damage, myocardial electronic abnormality, ventricular remodeling,heart function decrease and can cause sudden cardiac death, Whether or not to reach the expected myocardial perfusion and whether the heart function can improve after emergency PCI with TIMI grade 3 flow is not sure.The subject apply coronary angiography, electrocardiogram and echocardiography to evaluate and analysis the cardiac function and myocardial perfusion and to investigate the relationship between vascular reconstruction after emergency PCI with TIMI grade 3 flow and myocardial reperfusio,and the later and the prognosis of heart function.Methods Patients with STEMI after emergency PCI with TIMI grade 3 flow were selected from Department of Cardiology In Kunming city NO1 people’s Hospital during 2013.12 and 2014.12.The total number of cases is 2O8.The clinical data of sex, age, blood lipid, the history of smoking, diabetes,and hypertension were collected combineding with the result of coronary angiography and dynamic changes of electrocardiogram to comprehensive analysis the myocardial perfusion after vascular reconstruction. Completing intracardiac ultrasound Beckoning graph (UCG) examination after the seventh day of hospitalization to evaluation of cardiac systolic function, Measuring index include EF, SV, CO, CI, IVST%, LVPW%, FS and whether the segmental ventricular wall motion.Evaluation of cardiac diastolic function by measuring E/A,and LVMI.The overall assessment of heart function by Tei index.The patients with STAMI,meetting the inclusion criteria,is divided into the groups of A and B according to PCI after 2 hours ECG analysis of maximum elevation in lead ST segment resolution rate is up to 50%,It is considered ST-segment resolution rate (STR) of the ST segment elevation highest lead in electrocardiogram (ECG)after emergency PCI< 50% as group A (n=65), while ST segment resolution rate≥ 50% as group B (n=143),Respectively, monitoring the seventh day and the thirth month of cardiac function postoperatively in patients with STEMI status and after the PCI, the seventh day and the thirth month of cardiac function postoperatively in patients with STEMI status and after the PCI in A group respectively is defined as the Al and A2 group.while the seventh day and the thirth month of cardiac function postoperatively in patients with STEMI status and after the PCI in B group respectively is defined as the B1 and B2 group.Evaluating each index and each single index and multiple indices variance of cardiac function about A1 and B1 and A2 and B2, A1 and A2, B1 and B2 in the group to investigate the relations between the vascular remodeling and myocardial perfusion level,and myocardial perfusion level relationship with the prognosis of cardiac function.Results In 208 patients with STEMI, infarction related blood vessels are:single lesion have 49 cases, double branch lesions have 49 cases, three lesions have 49 cases.Paragraph with "criminals" vascular occlusion after balloon expansion were implanted with rapamycin coating stent, and PCI postoperative infarction related blood vessel TIMI flow grade Ⅲ, no "no reflow" and "slow blood flow" phenomenon.The highest raised ST segment fell back rate in the 2 hours after the PCI perioperative recanalization associated with infarction related blood levels of reperfusion.The highest lead in electrocardiogram (ECG)after emergency PCI< 50% have 98 cases, while ST segment resolution rate≥ 50% have 98 cases.Statistical analysis showed that by STR50%,the A group of good myocardial perfusion, includ A1a nd A2,evaluation the cardiac function with various monitoring indicators such as:EF, SV, CO, CI, LVPW% ,IVST%, FS, ventricular segmental wall motion, E/A, LVMI, Tei index vs each index of the group B,includ Bland B2,The two groups had significant statistical significance (P< 0.01). Results show that the comprehensive evaluation of cardiac function of A1 is poorer than the group of B1, after 3 months A2 heart function is more poor than B2 group. Follow-up of 3 months the each index of A1 group,such as EF, SV, CO, CI, LVPW%, IVST%, FS, ventricular segmental wall motion, E/A, LVMI, Tei index compare with A2 group has a statistical difference (P< 0.05). the each index of B1 group,such as EF, SV, CO, C1, LVPW%, IVST%, FS, ventricular segmental wall motion, E/A, LVMI, Tei index compare with B2 group has no statistical difference (P>0.05).Results show that the comprehensive assessment cardiac function of group B is better than group A,the group B has a good prognosis, while cardiac function in group A has a poor prognosis.Conclusions (1)The level of myocardial perfusion after PCI in patients with STEMI has a certain relationship with coronary angiography TIMI flow grade,ST segment recovery 2 hours in maximum elevation in lead,segmental wall motion and heart function.The good myocardial perfusion can improve segmental wall motion and heart functionl;myocardial (2)The myocardial perfusion in patients with STEMI after PCI and left ventricular remodeling has some correlation, good myocardial perfusion can reverse left ventricular remodeling in a certain extent.