冠状动脉支架置入术后大、小血管收缩。冠状动脉内硝酸甘油的作用及其与低密度脂蛋白胆固醇的关系。

Large and small vessel vasoconstriction following coronary artery stenting. Effect of intra coronary nitroglycerine and relation to LDL cholesterol.

作者信息

Larsen Alf Inge, Basran Rashpal, Anderson Todd, Goodhart David

机构信息

University of Bergen, Cardiology Division, Stavanger University Hospital, N-4001 Stavanger, Norway.

出版信息

Int J Cardiol. 2006 Oct 26;113(1):61-5. doi: 10.1016/j.ijcard.2005.10.027. Epub 2005 Dec 7.

DOI:10.1016/j.ijcard.2005.10.027

PMID:16337702

Abstract

UNLABELLED

Percutaneous coronary intervention (PCI) with stent placement induces epicardial coronary vasoconstriction, which is resolved by intracoronary (IC) nitroglycerine (NTG). The effect of stenting on microvascular coronary circulation and coronary blood flow (CBF) is less well established, and the effect of NTG on CBF following stenting is unknown. We examined the time course, extent, and influence of NTG, on PCI induced coronary vasoconstriction. Secondarily we also did an explorative analysis to evaluate the effect of increased levels of low density lipoprotein cholesterol (LDL-Cholesterol) on CBF after stenting.

METHODS

Single vessel PCI stent was performed in 19 patients (age 62+/-10 years). Immediately after PCI, a 0.014 Doppler flow-wire was positioned distal to the stent, and IC NTG 0.2 mg was given. Quantitative coronary angiography (QCA) and CBF measurements were taken at baseline, and at 10, 20 and 30 min following PCI. Further IC NTG 200 mug was given after the measurement at 30 min, and the measurements were repeated at 31 and 33 min. Coronary flow velocity reserve (CFVR) was measured with adenosine IC bolus.

RESULTS

Compared to baseline, there were significant reductions in CBF (24.5+/-18.3%), (35+/-30 vs. 28+/-25 ml/min, p=0.001) and coronary arterial diameter (5.1+/-5.4%) (2.63+/-0.54 vs. 2.50 mm+/-0.53, p=0.008) within 30 min following PCI. Subsequent IC NTG reversed both small (28+/-25 vs. 44+/-30 ml/min, p<0.001) and large (2.50+/-0.53 vs. 2.80+/-0.59 mm, p=0.001) vessel PCI induced vasoconstriction. LDL-cholesterol was significantly correlated to the percent reduction of blood-flow within 30 min (r=0.515, p=0.024, n=19) and to the maximal CBF after NTG (r=0.520, p=0.022, n=19).

CONCLUSION

Following PCI, both large and small vessel vasoconstriction are seen as manifest by a reduction in coronary conduit vessel diameter and in CBF. These effects are reversed by NTG. Serum levels of LDL are modestly related to the reduction of CBF and to the degree of NTG induced vasodilatation of coronary micro-vasculature.

摘要

未标注

冠状动脉支架置入术（PCI）可诱发心外膜冠状动脉血管收缩，而冠状动脉内（IC）注射硝酸甘油（NTG）可缓解这种收缩。支架置入术对冠状动脉微循环和冠状动脉血流（CBF）的影响尚不明确，且NTG对支架置入术后CBF的影响也未知。我们研究了NTG对PCI诱发冠状动脉血管收缩的时间进程、程度及影响。其次，我们还进行了一项探索性分析，以评估低密度脂蛋白胆固醇（LDL-胆固醇）水平升高对支架置入术后CBF的影响。

方法

对19例患者（年龄62±10岁）进行单支血管PCI支架置入术。PCI术后立即将0.014多普勒血流导丝置于支架远端，并给予IC NTG 0.2 mg。在基线时以及PCI术后10、20和30分钟进行定量冠状动脉造影（QCA）和CBF测量。在30分钟测量后再给予IC NTG 200 μg，并在31和33分钟重复测量。通过冠状动脉内注射腺苷团注测量冠状动脉血流储备（CFVR）。

结果

与基线相比，PCI术后30分钟内CBF显著降低（24.5±18.3%）（35±30 vs. 28±25 ml/min，p = 0.001），冠状动脉直径显著减小（5.1±5.4%）（2.63±0.54 vs. 2.50 mm±0.53，p = 0.008）。随后的IC NTG逆转了小血管（28±25 vs. 44±30 ml/min，p < 0.001）和大血管（2.50±0.53 vs. 2.80±0.59 mm，p = 0.001）PCI诱发的血管收缩。LDL-胆固醇与30分钟内血流减少百分比显著相关（r = 0.515，p = 0.024，n = 19），与NTG后的最大CBF显著相关（r = 0.520，p = 0.022，n = 19）。