ST 段抬高型心肌梗死患者后处理对梗死面积和左心室射血分数的长期影响。

Long-term impact of postconditioning on infarct size and left ventricular ejection fraction in patients with ST-elevation myocardial infarction.

机构信息

Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden.

出版信息

BMC Cardiovasc Disord. 2013 Mar 25;13:22. doi: 10.1186/1471-2261-13-22.

BACKGROUND

Ischemic postconditioning (PostC), reperfusion in brief cycles, is known to induce short-term reduction in infarct size in patients with ST elevation myocardial infarction (STEMI), especially among those with large myocardium at risk (MaR). The aim of the present study was to investigate the long-term effect of PostC on infarct size and left ventricular ejection fraction (LVEF).

METHODS

Sixty-eight patients with a first STEMI were randomised to primary percutaneous coronary intervention (PCI) (n = 35) or PCI followed by PostC (n = 33). MaR was determined as abnormally contracting segments on left ventricular angiogram. Cardiac magnetic resonance was performed at 3 and 12 months for the determination of infarct size and LVEF.

RESULTS

Overall there was no difference in infarct size expressed in percentage of MaR between patients randomised to the control (31%; 23, 41) and PostC (31%; 23, 43) groups at 12 months. Likewise there was no difference in LVEF between control (49%; 41, 55) and PostC (52%; 45, 55). In contrast, patients in the PostC group with MaR in the upper quartile had a significantly smaller infarct size (29%; 18, 38) than those in the control group (40%; 34, 48; p < 0.05) at 12 months. In these patients LVEF was higher in the PostC (47%; 43, 50) compared to the control group (38%; 34, 42; p < 0.01).

CONCLUSIONS

In this long-term follow-up study PostC did not reduce infarct size in relation to MaR or improved LVEF in the overall study population. However, the present data suggest that PostC exerts long-term beneficial effects in patients with large MaR thereby extending previously published short-term observations.

TRIAL REGISTRATION

Karolinska Clinical Trial Registration (http://www.kctr.se). Unique identifier: CT20080014.

背景

缺血后处理（PostC），即短暂的再灌注循环，已知可减少 ST 段抬高型心肌梗死（STEMI）患者的梗死面积，尤其是在存在大心肌风险（MaR）的患者中。本研究旨在探讨 PostC 对梗死面积和左心室射血分数（LVEF）的长期影响。

方法

68 例首次发生 STEMI 的患者被随机分为直接经皮冠状动脉介入治疗（PCI）组（n = 35）或 PCI 后行 PostC 组（n = 33）。MaR 是通过左心室造影确定的异常收缩节段。在 3 个月和 12 个月时进行心脏磁共振检查，以确定梗死面积和 LVEF。

结果

总体而言，在 12 个月时，随机分为对照组（31%；23,41）和 PostC 组（31%；23,43）的患者之间，MaR 表达的梗死面积百分比没有差异。同样，对照组（49%；41,55）和 PostC 组（52%；45,55）之间的 LVEF 也没有差异。相反，PostC 组 MaR 处于上四分位数的患者的梗死面积明显小于对照组（40%；34,48；p < 0.05）。在这些患者中，PostC 组的 LVEF 更高（47%；43,50），而对照组的 LVEF 更低（38%；34,42；p < 0.01）。