急性心筋梗塞に対するRESCUETMカテーテル使用後の冠血流改善不良群の予測因子

Predictors for Unsuccessful Reperfusion Immediately after Performing RESCUETM Catheter in Patients with Acute Myocardial Infarction

要旨

　右冠動脈を責任血管とする急性心筋梗塞患者において，RESCUE^TMカテーテル使用後の冠血流改善不良群の予測因子を検討した．対象は2000年5月から2002年6月の期間に当院で緊急冠動脈造影を施行し，右冠動脈に多量の血栓を有した急性心筋梗塞連続66例である．RESCUE^TMカテーテル使用直後のTIMI frame count(TFC)を測定し，冠血流改善良好群(TFC＜40)，冠血流改善不良群(TFC≧40)に分類した．両群間での比較および多変量解析を行い，冠血流改善不良に対する独立した予測因子を検討した．2群間の比較では再潅流までの時間，冠動脈径，手技時間，末梢塞栓の項目で有意差を認めた．多変量解析では冠動脈径が大きいことと再潅流までの時間が長いことが冠血流改善不良の独立した予測因子であった．以上より，右冠動脈を責任血管とする急性心筋梗塞患者においては，冠動脈径が大きく，再潅流までの時間が長い場合，RESCUE^TMカテーテルによる十分な冠血流改善効果が期待できないことが示唆された．

Summary

　Background: The purpose of this study was to identify clinical and anatomical characteristics which may not benefit from RESCUE^TM catheter in patients with acute myocardial infarction (AMI).

　Methods: Sixty-six consecutive AMI patients, who had extensive thrombi in the right coronary artery (RCA), were enrolled in this study. We measured Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) immediately after performing RESCUE^TM catheter and defined unsuccessful reperfusion as TFC≧40. The patients were divided into two groups: TFC＜40 group (n＝55) and TFC≧40 group(n＝11). The two groups were compared and multivariate and multivariate analyses were performed to identify clinical and anatomical factors in predicting unsuccessful reperfusion.

　Results: In a multivariate model, large vessel diameter and late recanalization were the independent predictors for unsuccessful reperfusion (p＜0.05).

　Conclusion: Large vessel diameter and late recanalization are independently associated with unsuccessful reperfusion immediately after RESCUE^TM catheter in patients with AMI related to RCA.