CREATIS, CNRS UMR 5220, INSERM U1044, Université de Lyon, Lyon, France.
J Am Coll Cardiol. 2012 Jun 12;59(24):2175-81. doi: 10.1016/j.jacc.2012.03.026.
This study aimed to determine whether post-conditioning at the time of percutaneous coronary intervention could reduce reperfusion-induced myocardial edema in patients with acute ST-segment elevation myocardial infarction (STEMI).
Myocardial edema is a reperfusion injury with potentially severe consequences. Post-conditioning is a cardioprotective therapy that reduces infarct size after reperfusion, but no previous studies have analyzed the impact of this strategy on reperfusion-induced myocardial edema in humans.
Fifty patients with STEMI were randomly assigned to either a control or post-conditioned group. Cardiac magnetic resonance imaging was performed within 48 to 72 h after admission. Myocardial edema was measured by T2-weighted sequences, and infarct size was determined by late gadolinium enhancement sequences and creatine kinase release.
The post-conditioned and control groups were similar with respect to ischemia time, the size of the area at risk, and the ejection fraction before percutaneous coronary intervention. As expected, post-conditioning was associated with smaller infarct size (13 ± 7 g/m(2) vs. 21 ± 14 g/m(2); p = 0.01) and creatine kinase peak serum level (median [interquartile range]: 1,695 [1,118 to 3,692] IU/l vs. 3,505 [2,307 to 4,929] IU/l; p = 0.003). At reperfusion, the extent of myocardial edema was significantly reduced in the post-conditioned group as compared with the control group (23 ± 16 g/m(2) vs. 34 ± 18 g/m(2); p = 0.03); the relative increase in T2W signal intensity was also significantly lower (p = 0.02). This protective effect was confirmed after adjustment for the size of the area at risk.
This randomized study demonstrated that post-conditioning reduced infarct size and edema in patients with reperfused STEMI.
本研究旨在确定经皮冠状动脉介入治疗时的后处理是否可以减轻急性 ST 段抬高型心肌梗死（STEMI）患者再灌注引起的心肌水肿。
心肌水肿是一种再灌注损伤，可能会产生严重后果。后处理是一种心肌保护治疗方法，可以减少再灌注后的梗死面积，但以前的研究并未分析该策略对人类再灌注引起的心肌水肿的影响。
将 50 例 STEMI 患者随机分为对照组和后处理组。入院后 48 至 72 小时内行心脏磁共振成像检查。通过 T2 加权序列测量心肌水肿，通过晚期钆增强序列和肌酸激酶释放测定梗死面积。
后处理组和对照组在缺血时间、危险区大小和经皮冠状动脉介入治疗前射血分数方面相似。正如预期的那样，后处理与较小的梗死面积（13±7 g/m2 比 21±14 g/m2；p=0.01）和肌酸激酶峰值血清水平（中位数[四分位数间距]：1695[1118 至 3692] IU/l 比 3505[2307 至 4929] IU/l；p=0.003）相关。再灌注时，与对照组相比，后处理组的心肌水肿程度明显降低（23±16 g/m2 比 34±18 g/m2；p=0.03）；T2W 信号强度的相对增加也明显较低（p=0.02）。这种保护作用在调整危险区大小后得到了证实。
这项随机研究表明，后处理可减轻再灌注后 STEMI 患者的梗死面积和水肿。
