Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy.
EuroIntervention. 2012 Aug;8(4):470-6. doi: 10.4244/EIJV8I4A74.
Considerable interest has been focused in recent years on the role of distal embolisation as a major determinant of impaired reperfusion after primary angioplasty for STEMI. The aim of the current study was to evaluate in a large cohort of STEMI patients undergoing primary angioplasty with glycoprotein (Gp) IIb-IIIa inhibitors, whether the impact of distal embolisation on myocardial perfusion and survival may depend on time-to-treatment.
Our population is represented by 1,182 patients undergoing primary angioplasty for STEMI included in the EGYPT database. Patients were grouped according to time-to-treatment (<3 hours, 3-6 hours, >6 hours). Distal embolisation was defined as an abrupt "cutoff" in the main vessel or one of the coronary branches of the infarct-related artery, distal to the angioplasty site. Myocardial perfusion was evaluated by angiography or ST-segment resolution, whereas infarct size was estimated by using peak creatine kinase (CK) and CK-MB. Follow-up data were collected between 30 days and one year after primary angioplasty. Distal embolisation was observed in 132 patients (11.1%) and tended to occur more frequently in late presenters (p=0.067). Patients with distal embolisation less often had post-procedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow (p<0.001), post-procedural myocardial blush grade (MBG) 2-3 (p<0.001), complete ST-segment resolution (p=0.021) and larger infarct size (p=0.012). Distal embolisation was associated with a significantly higher mortality (9.2% vs. 2.7%, heart rate [HR] [95% CI]=3.41 [1.73-6.71], p<0.0001). The impact of distal embolisation on myocardial perfusion and survival persisted for all time intervals.
This study showed that among STEMI patients treated with Gp IIb-IIIa inhibitors, the negative impact of distal embolisation on myocardial perfusion and mortality is independent of the time from symptom onset to balloon angioplasty.
近年来，人们对原发性经皮冠状动脉介入治疗（PCI）治疗 ST 段抬高型心肌梗死（STEMI）后再灌注受损的远端栓塞作用产生了浓厚的兴趣。本研究的目的是在接受血小板糖蛋白（Gp）IIb-IIIa 抑制剂的原发性 PCI 治疗的 STEMI 大患者队列中，评估远端栓塞对心肌灌注和生存的影响是否取决于治疗时间。
我们的人群由纳入 EGYPT 数据库的 1182 例接受原发性 PCI 治疗的 STEMI 患者组成。根据治疗时间（<3 小时、3-6 小时、>6 小时）将患者分为两组。远端栓塞定义为梗死相关动脉的主血管或其中一个分支的血管突然“中断”，位于血管成形术部位的远端。通过血管造影或 ST 段分辨率评估心肌灌注，通过峰值肌酸激酶（CK）和 CK-MB 估计梗死面积。在原发性 PCI 治疗后 30 天至 1 年内收集随访数据。在 132 例患者（11.1%）中观察到远端栓塞，并且在晚期就诊者中更常发生（p=0.067）。远端栓塞患者术后经血栓溶解治疗的心肌梗死（TIMI）血流分级 3 级（p<0.001）、术后心肌染色分级 2-3 级（p<0.001）、完全 ST 段分辨率（p=0.021）和较大的梗死面积（p=0.012）较低。远端栓塞与死亡率显著升高相关（9.2% vs. 2.7%，心率[HR]（95%CI）=3.41（1.73-6.71），p<0.0001）。远端栓塞对心肌灌注和生存的影响在所有时间间隔内持续存在。
本研究表明，在接受 Gp IIb-IIIa 抑制剂治疗的 STEMI 患者中，远端栓塞对心肌灌注和死亡率的负面影响独立于从症状发作到球囊血管成形术的时间。
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