Ishii Hideki, Amano Tetsuya, Matsubara Tatsuaki, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine.
Curr Cardiol Rev. 2008 Aug;4(3):223-30. doi: 10.2174/157340308785160598.
In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease.
近年来，经皮冠状动脉介入治疗（PCI）已成为治疗冠状动脉疾病的成熟技术。PCI可改善冠状动脉疾病患者的症状，并且手术安全性不断提高。然而，即使在择期手术中，也有报道称围手术期和术后心肌损伤，包括血管造影显示的冠状动脉血流缓慢、微血管栓塞以及心肌酶（如肌酸激酶、肌钙蛋白T和肌钙蛋白I）水平升高。此外，在急性冠状动脉综合征患者中，心肌再灌注开始时可能发生心肌再灌注损伤，导致组织损伤和心脏功能障碍。由于心肌损伤患者比无心肌损伤患者更容易发生大面积心肌梗死，且长期预后更差，因此预防冠心病患者PCI期间和/或术后的心肌损伤非常重要。迄今为止，许多研究表明，辅助药物治疗可抑制PCI手术期间的心肌损伤并增加冠状动脉血流。在本综述中，我们强调药物治疗联合PCI在减轻冠心病患者心肌损伤方面的作用。
