Trabattoni Daniela, Bartorelli Antonio L, Fabbiocchi Franco, Montorsi Piero, Ravagnani Paolo, Pepi Mauro, Celeste Fabrizio, Maltagliati Anna, Marenzi Giancarlo, O'Neill William W
Centro Cardiologico Monzino IRCCS, Institute of Cardiology, University of Milan, Milan, Italy.
Catheter Cardiovasc Interv. 2006 Jun;67(6):859-65. doi: 10.1002/ccd.20704.
To assess left ventricle function recovery, ST-segment changes, and enzyme kinetic in ST-elevation myocardial infarction patients treated with intracoronary hyperoxemic perfusion (IHP) after primary percutaneous coronary intervention and compare them with the results obtained in control patients.
IHP has been shown to attenuate microvascular reperfusion injury, which may result in poor LV function recovery despite successful primary percutaneous coronary intervention.
Twenty seven anterior ST-elevation myocardial infarction patients treated < or = 12 hr after symptom onset by primary percutaneous coronary intervention were subjected to selective IHP into the left anterior descending coronary artery for 90 min. They were compared with 24 anterior ST-elevation myocardial infarction control patients matched in clinical and angiographic characteristics and treated with conventional primary percutaneous coronary intervention. Left ventricular function recovery was evaluated by serial 2D contrast echocardiography.
Left anterior descending coronary artery recanalization was successful in all patients. After IHP (100% successful, duration 90 +/- 5.4 min), patients showed a 4.8 +/- 2.2 hr shorter time-to-peak creatine kinase release (P = 0.001), a shorter creatine kinase half-life period (23.4 +/- 8.9 hr vs. 30.5 +/- 5.8 hr, P = 0.006), and a higher rate of complete ST-segment resolution (78% vs. 42%, P = 0.01). A significant improvement of mean left ventricular ejection fraction (from (44 +/- 9)% to (55 +/- 11)%, P < 0.001) and wall motion score index (from 1.77 +/- 0.2 to 1.39 +/- 0.4, P < 0.001) was observed at 3 months in IHP patients only.
After successful primary coronary intervention, IHP is associated with significant left ventricular function recovery when compared to conventional treatment. Enzyme kinetic and ST-segment changes suggest faster and more complete microvascular reperfusion and may explain the salutary effects of this new therapy on left ventricular function.
评估经皮冠状动脉介入治疗后接受冠状动脉内高氧灌注（IHP）的ST段抬高型心肌梗死患者的左心室功能恢复情况、ST段变化及酶动力学，并与对照组患者的结果进行比较。
IHP已被证明可减轻微血管再灌注损伤，尽管经皮冠状动脉介入治疗成功，但仍可能导致左心室功能恢复不良。
27例症状发作后≤12小时接受经皮冠状动脉介入治疗的前壁ST段抬高型心肌梗死患者，在左前降支冠状动脉内进行选择性IHP 90分钟。将他们与24例临床和血管造影特征匹配并接受传统经皮冠状动脉介入治疗的前壁ST段抬高型心肌梗死对照患者进行比较。通过连续二维对比超声心动图评估左心室功能恢复情况。
所有患者左前降支冠状动脉再通成功。IHP后（成功率100%，持续时间90±5.4分钟），患者肌酸激酶释放达峰时间缩短4.8±2.2小时（P = 0.001），肌酸激酶半衰期缩短（23.4±8.9小时对30.5±5.8小时，P = 0.006），ST段完全恢复率更高（78%对42%，P = 0.01）。仅IHP组患者在3个月时平均左心室射血分数有显著改善（从（44±9）%提高到（55±11）%，P < 0.001），室壁运动评分指数从1.77±0.2提高到1.39±0.4（P < 0.001）。
与传统治疗相比，成功的冠状动脉介入治疗后，IHP与显著的左心室功能恢复相关。酶动力学和ST段变化提示微血管再灌注更快、更完全，这可能解释了这种新疗法对左心室功能的有益作用。
