Werner Gerald S, Lang Klaus, Kuehnert Helmuth, Figulla Hans R
Clinic for Internal Medicine III, Friedrich-Schiller-University Jena, Jena, Germany.
Catheter Cardiovasc Interv. 2002 Dec;57(4):444-51. doi: 10.1002/ccd.10375.
No-reflow is a frequent observation during direct PTCA for acute myocardial infarction (AMI) and associated with a poor clinical outcome. This study assesses the value of verapamil for reversal of no-reflow during PTCA for AMI. In a consecutive series of 212 direct or rescue PTCAs for AMI, a TIMI flow grade < 3 was observed in 23 patients (10.8%). Ten of these patients had received GP IIb/IIIa antagonists before PTCA. Seven patients with AMI and TIMI grade 3 flow served as controls. All lesions were treated by stents. In 18 patients with systolic blood pressure > 90 mm Hg, nitroglycerine (0.1 mg i.c.) was given. Verapamil (1 mg over 2 min) was given via an infusion catheter distal to the angioplasty site. Before and after nitroglycerine, after verapamil, and 15 min later coronary flow was assessed by the TIMI frame count method (TFC). Nitroglycerine had no effect on TFC. Verapamil reduced TFC from 56 +/- 9 frames to 24 +/- 4 (P < 0.001). In controls, TFC did not change significantly. The TIMI flow grade was restored to TIMI flow grade 3 in 65%. In two of seven right coronary and one of three circumflex arteries, intermittent AV block II occurred during verapamil injection, which disappeared after atropine. No-reflow after PTCA for AMI can be reversed by intracoronary verapamil. This supports the hypothesis that no-reflow is caused by acute microvascular dysfunction probably because of a disorder in calcium homeostasis or microvascular spasm.
无复流现象在急性心肌梗死（AMI）直接经皮冠状动脉腔内血管成形术（PTCA）过程中经常出现，且与不良临床预后相关。本研究评估了维拉帕米在AMI的PTCA过程中逆转无复流现象的价值。在连续212例直接或补救性AMI的PTCA病例中，23例患者（10.8%）观察到心肌梗死溶栓试验（TIMI）血流分级<3级。其中10例患者在PTCA前接受过血小板糖蛋白IIb/IIIa拮抗剂治疗。7例AMI且TIMI 3级血流的患者作为对照。所有病变均采用支架治疗。18例收缩压>90 mmHg的患者给予硝酸甘油（0.1 mg静脉注射）。通过血管成形术部位远端的输注导管给予维拉帕米（2分钟内1 mg）。在给予硝酸甘油前后、给予维拉帕米后以及15分钟后，采用TIMI帧计数法（TFC）评估冠状动脉血流。硝酸甘油对TFC无影响。维拉帕米使TFC从56±9帧降至24±4帧（P<0.001）。对照组中，TFC无显著变化。65%的患者TIMI血流分级恢复至TIMI 3级血流。在7支右冠状动脉中的2支和3支回旋支中的1支，维拉帕米注射期间出现间歇性二度房室传导阻滞，阿托品治疗后消失。AMI的PTCA术后无复流现象可通过冠状动脉内注射维拉帕米逆转。这支持了无复流现象是由急性微血管功能障碍引起的假说，可能是由于钙稳态紊乱或微血管痉挛所致。
