Brodie Bruce R, Webb John, Cox David A, Qureshi Mansoor, Kalynych Anna, Turco Mark, Schultheiss Heinz P, Dulas Daniel, Rutherford Barry, Antoniucci David, Stuckey Tom, Krucoff Mitch, Gibbons Raymond, Lansky Alexandra, Na Yingbo, Mehran Roxana, Stone Gregg W
LeBauer Cardiovascular Research Foundation and Moses Cone Heart and Vascular Center, Greensboro, North Carolina, USA.
Am J Cardiol. 2007 Jun 15;99(12):1680-6. doi: 10.1016/j.amjcard.2007.01.047. Epub 2007 May 7.
The impact of time to treatment on outcomes after primary percutaneous coronary intervention (PCI) is controversial, and there are few data about time to treatment and infarct size. The EMERALD trial randomly assigned 501 high-risk patients with ST-elevation myocardial infarction undergoing primary PCI to stenting with or without GuardWire (Medtronic, Santa Rosa, California) distal protection. Infarct size using sestamibi imaging at 5 to 14 days and clinical outcomes were examined by time to treatment. There were no differences in outcomes between distal protection and control patients. Shorter time to reperfusion (<2 vs 2 to 3 vs >3 to 4 vs >4 hours) was associated with smaller infarct size (2% vs 9% vs 12% vs 11%, p=0.026), trends for better myocardial blush (p=0.08), and lower 6-month mortality rates (0% vs 0% vs 2.4% vs 5.3%, p=0.06). Incremental delays in reperfusion after 2 hours had little impact on infarct size. Shorter time to reperfusion impacted on infarct size in patients with anterior infarction (0% vs 17% vs 20.5% vs 30.5%, p=0.026), but not nonanterior infarction (3% vs 7% vs 7.5% vs 10%, p=0.23, p=0.022 for interaction). In conclusion, very early reperfusion with primary PCI is associated with smaller infarct size and has a much greater impact in anterior versus nonanterior infarction. Incremental delays in reperfusion after 2 hours have less effect on infarct size. These data have implications regarding the triage of patients for primary PCI.
初次经皮冠状动脉介入治疗（PCI）的治疗时间对预后的影响存在争议，且关于治疗时间与梗死面积的数据较少。EMERALD试验将501例接受初次PCI的高危ST段抬高型心肌梗死患者随机分为接受有或无GuardWire（美敦力公司，加利福尼亚州圣罗莎）远端保护装置支架置入术两组。采用锝-99m甲氧基异丁基异腈显像在5至14天评估梗死面积，并根据治疗时间对临床预后进行检查。远端保护组与对照组患者的预后无差异。再灌注时间较短（<2小时与2至3小时与>3至4小时与>4小时）与梗死面积较小相关（2% vs 9% vs 12% vs 11%，p=0.026），心肌灌注呈改善趋势（p=0.08），6个月死亡率较低（0% vs 0% vs 2.4% vs 5.3%，p=0.06）。2小时后再灌注的逐渐延迟对梗死面积影响较小。再灌注时间较短对前壁梗死患者的梗死面积有影响（0% vs 17% vs 20.5% vs 30.5%，p=0.026），但对非前壁梗死患者无影响（3% vs 7% vs 7.5% vs 10%，p=0.23，交互作用p=0.022）。总之，初次PCI极早期再灌注与较小的梗死面积相关，且对前壁梗死的影响比对非前壁梗死的影响大得多。2小时后再灌注的逐渐延迟对梗死面积的影响较小。这些数据对初次PCI患者的分诊具有重要意义。
