直接经皮冠状动脉介入治疗对前壁 ST 段抬高型心肌梗死患者非罪犯血管血流灌注的影响。

Impact of primary percutaneous coronary intervention on blood perfusion in nonculprit artery in patients with anterior ST elevation myocardial infarction.

机构信息

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Vessel Diseases, Beijing 100029, China.

出版信息

Chin Med J (Engl). 2013 Jan;126(1):22-6.

PMID:23286472

Abstract

BACKGROUND

Recent studies have demonstrated that epicardial flow in nonculprit arteries, which has been assumed to be normal, was slowed in the setting of ST-elevation myocardial infarction (STEMI). However, the impact of primary percutaneous coronary intervention (PCI) on blood perfusion in nonculprit arteries in patients with STEMI has not been clarified. The purpose of this study was to investigate the impact of primary PCI on blood perfusion in nonculprit arteries in patients with STEMI and correlated clinical factors.

METHODS

A total of 117 patients with anterior wall STEMI, the culprit artery being the left anterior descending artery (LAD), undergoing primary PCI (the study group) and 100 patients with normal coronary angiography (the control group) were enrolled. To observe the differences of corrected TIMI frame count (cTFC) and myocardial blush grade (MBG) before and after primary PCI in both culprit and nonculprit arteries, the left circumflex coronary artery (LCX), cTFC and MBG in the LAD and LCX were measured in the study group and control group. The study group was divided into three groups; reflow in the culprit artery group (the R group), no reflow in culprit artery group (the NR group), and no reflow in both the culprit artery and nonculprit artery group (the NRB group) according to MBG grade. The level of serum C-reactive protein (CRP), catecholamine, and fibroblast growth factor-21 (FGF21) were assayed. The clinical and angiographic characteristics were also analyzed.

RESULTS

cTFC (28.1 ± 24.3 vs. 20.3 ± 19.3, P < 0.05) and MBG in the LCX were different in the study group compared to the control group before primary PCI. cTFC (25.2 ± 22.3 vs. 28.1 ± 24.3, P < 0.05) and the MBG level in the LCX were improved after successful primary PCI, but were not recovered to the normal level. Patients with no reflow in the culprit artery had a higher incidence of no-reflow in the nonculprit artery (78% vs. 19%, P < 0.0001), and the levels of CRP ((3.29 ± 1.31) mg/dl vs. (2.51 ± 1.14) mg/dl vs. (2.93 ± 1.07) mg/dl, P < 0.05, respectively), catecholamine ((epinephrine (693.48 ± 89.78) pg/ml vs. (398.12 ± 93.28) pg/ml vs. (562.54 ± 96.22) pg/ml, P < 0.0001, respectively), and norepinephrine ((7012.43 ± 932.47) pg/ml vs. (4012.34 ± 814.16) pg/ml vs. (5549.03 ± 912.65) pg/ml, P < 0.0001, respectively)) in the NRB group were higher than those in the R group and NR group. The level of FGF21 ((0.299 ± 0.093) ng/ml vs. (0.612 ± 0.071) ng/ml vs. (0.428 ± 0.074) ng/ml, P < 0.0001 respectively) in the NRB group was lower than that in the R group and NR group.

CONCLUSIONS

The blood perfusion in the nonculprit artery may be impaired in patients with STEMI. Although nonculprit artery perfusion may be improved after successful primary PCI, it is still lower than that in the control group, and may be involved in inflammation and spasms.

摘要

背景

最近的研究表明，在 ST 段抬高型心肌梗死（STEMI）患者中，假定正常的心外膜血流速度减慢。然而，直接经皮冠状动脉介入治疗（PCI）对 STEMI 患者非罪犯动脉的血液灌注的影响尚未明确。本研究旨在探讨直接 PCI 对 STEMI 患者非罪犯动脉血液灌注的影响及其相关临床因素。

方法

共纳入 117 例前壁 STEMI 患者（罪犯血管为左前降支）行直接 PCI（研究组）和 100 例冠状动脉造影正常的患者（对照组）。观察两组患者罪犯和非罪犯血管校正 TIMI 帧数（cTFC）和心肌灌注分级（MBG）的变化。测量研究组和对照组左回旋支（LCX）的 cTFC 和 MBG。根据 MBG 分级，研究组分为再灌注组（R 组）、罪犯血管无再灌注组（NR 组）和罪犯血管及非罪犯血管均无再灌注组（NRB 组）。测定血清 C 反应蛋白（CRP）、儿茶酚胺和成纤维细胞生长因子 21（FGF21）水平，并分析临床和血管造影特征。

结果

与对照组相比，研究组直接 PCI 前 LCX 的 cTFC（28.1 ± 24.3 vs. 20.3 ± 19.3，P < 0.05）和 MBG 不同。直接 PCI 后，LCX 的 cTFC（25.2 ± 22.3 vs. 28.1 ± 24.3，P < 0.05）和 MBG 水平得到改善，但未恢复到正常水平。罪犯血管无再灌注的患者非罪犯血管无再灌注的发生率更高（78% vs. 19%，P < 0.0001），且 CRP（（3.29 ± 1.31）mg/dl vs.（2.51 ± 1.14）mg/dl vs.（2.93 ± 1.07）mg/dl，P < 0.05）、儿茶酚胺（（肾上腺素（693.48 ± 89.78）pg/ml vs.（398.12 ± 93.28）pg/ml vs.（562.54 ± 96.22）pg/ml，P < 0.0001）和去甲肾上腺素（（7012.43 ± 932.47）pg/ml vs.（4012.34 ± 814.16）pg/ml vs.（5549.03 ± 912.65）pg/ml，P < 0.0001））水平在 NRB 组较高。NRB 组的 FGF21（（0.299 ± 0.093）ng/ml vs.（0.612 ± 0.071）ng/ml vs.（0.428 ± 0.074）ng/ml，P < 0.0001）水平较低。