Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Clin Cardiol. 2010 Jul;33(7):439-44. doi: 10.1002/clc.20796.
It has been proved in animal models that postconditioning (PC) could attenuate reperfusion injury. But there are not many clinical studies on the application of PC.
Four cycles of 1-minute balloon inflation and deflation, following initial balloon reperfusion in ST-segment elevation myocardial infarction (MI) but before stenting, might improve clinical outcomes compared with primary percutaneous coronary intervention (PCI) alone.
Forty-three patients diagnosed with acute MI were randomly assigned to 2 groups: the control group (n = 20) and the PC group (n = 23). Blood samples were obtained and assayed for creatine kinase MB (CK-MB) and high-sensitive C-reactive protein. Electrocardiogram, echocardiography, and rest technetium Tc 99m-sestamibi (99mTc-MIBI) myocardial perfusion single-photon emission computed tomography (SPECT) were performed.
The control group presented with higher peak CK-MB as compared with the PC group (351.9 +/- 153.6 vs 247.7 +/- 118.3 U/L, P = 0.028) as well as the area under the curve (AUC) of CK-MB (8040 +/- 3358 vs 5955 +/- 2509, P = 0.04). After PCI, PC was associated with a lower level of hs-CRP in comparison with the control group (5.5 +/- 4.5 vs 9.5 +/- 5.2 mg/L, P = 0.019). More patients in the PC group had complete ST-segment resolution than did patients in the control group (82.6% vs 45.0%, P = 0.049). Left ventricle ejection fraction was better in the PC group than in the control group (0.57 +/- 0.09 vs 0.47 +/- 0.11, P = 0.002). Compared with the control group, PC greatly reduced infarct size, by 46% as measured by SPECT (13 +/- 11.2% vs 24.2 +/- 10.6%, P = 0.002).
This study indicated that PC in emergent PCI was a valuable modification of primary PCI.
动物模型研究已经证实，后处理（PC）可以减轻再灌注损伤。但在临床应用中，PC 的研究并不多。
在 ST 段抬高型心肌梗死（MI）患者初始球囊再灌注后，在支架置入前进行 4 个 1 分钟的球囊充气/放气循环，与单纯经皮冠状动脉介入治疗（PCI）相比，可能改善临床结局。
43 例确诊为急性 MI 的患者被随机分为两组：对照组（n = 20）和 PC 组（n = 23）。采集血样并检测肌酸激酶同工酶 MB（CK-MB）和高敏 C 反应蛋白。行心电图、超声心动图和静息锝 99m-甲氧基异丁基异腈（99mTc-MIBI）心肌灌注单光子发射计算机断层扫描（SPECT）。
与 PC 组相比，对照组的 CK-MB 峰值更高（351.9±153.6 vs 247.7±118.3 U/L，P=0.028），CK-MB 曲线下面积（AUC）也更高（8040±3358 vs 5955±2509，P=0.04）。与对照组相比，PC 后 hs-CRP 水平更低（5.5±4.5 vs 9.5±5.2 mg/L，P=0.019）。PC 组患者 ST 段完全缓解的比例高于对照组（82.6% vs 45.0%，P=0.049）。与对照组相比，PC 组左心室射血分数更高（0.57±0.09 vs 0.47±0.11，P=0.002）。与对照组相比，SPECT 测量的梗死面积减少了 46%（13±11.2% vs 24.2±10.6%，P=0.002）。
本研究表明，在急诊 PCI 中应用 PC 是一种有价值的 PCI 改良方法。
