经皮冠状动脉介入治疗中心脏后处理。
Postconditioning the human heart in percutaneous coronary intervention.
机构信息
Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
出版信息
Clin Cardiol. 2010 Jul;33(7):439-44. doi: 10.1002/clc.20796.
BACKGROUND
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.
HYPOTHESIS
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
This study indicated that PC in emergent PCI was a valuable modification of primary PCI.
背景
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。
假说
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。
方法
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）。
结果
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）。
结论
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。
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