Development Of Myocardial Perfusion And The Clinical Meaning In Patients With Acute Myocardial Infarction After The Emergency Percutaneous Coronary Intervention

Objective To investigate the development of myocardial microvascular perfusion andthe clinical significance of no reflow phenomenon in patients with acute ST segment elevation myocardial infarction after recanalization of infarction-related artery(IRA).Methods All patients with first acute ST segment elevation myocardial infarctionunderwent successful emergency percutaneous coronary intervention(PCI) within 6 hours after the symptom onset, Thrombolysis in myocardial infarction(TIMI) 2 or 3 grade flow of IRA was obtained. Every patient was received Single-photon emission computed tomography (SPECT) immediately after PCI and repeated at 24 hours , 2th week and 3th month after PCI. We evaluated the myocardial microcirculation perfusion by SPECT myocardial perfusion defect score, and detect LVEF(left ventricular ejection fraction), LVEDV(left ventricular end-diastolic volume) and LVESV(left ventricular end-systolic volume) of each time. 48 patients were assigned to no-reflow group (n=22) and reflow group (n=26) by SPECT score. To analyze the development of myocardial perfusion defect score, LVEF, LVEDV and and LVESV in patients of no-reflow, and compare with patients of reflow.Results (1) At once , 24 hour, 2 week and 3 month after PCI, the mean value ofSPECT myocardial perfusion defect score is 8.7±2.4, 6.8 ± 2.4, 4.8±2.6 and 4.3 ± 1.9 respectively in patients of no-reflow, It is 4.1 ±1.0, 1.7±1.2, 0.5 ± 1.1 and 0.4± 1.0 in patients of reflow; the change between every o'clock have remarkable difference (P< 0.05) except between 2 week and 3 month. While the patients in no-reflow group have a higher myocardial perfusion defect score than those in reflow group at every same o'clock (P<0.01).(2) At once , 24 hour, 2 week and 3 month after PCI, the mean value of LVEF in patients of no-reflow is 46.7 ± 8.0, 44.3 ± 7.6, 46.9 ± 6.5 and 52.4 ± 6.3percent...