Sanatkar Masoud, Shemirani Hassan, Sanei Hamid, Pourmoghaddas Masoud, Rabiei Katayoun
Fellowship Resident, Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
ARYA Atheroscler. 2013 Jan;9(1):22-8.
Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST elevation myocardial infarction (STEMI). However, the required equipments are not available in all hospitals. Thus, due to shortage of time, some patients receive thrombolysis therapy first. Patients with chest pain and/or persistent ST segment elevation will then undergo rescue percutaneous coronary intervention (PCI). The present study evaluated and compared the frequency of no-reflow phenomenon and 24-hour complications after PCI among patients who underwent PPCI or rescue PCI.
This cross-sectional study assessed no-reflow phenomenon, 24-hour complications, and thrombolysis in myocardial infarction (TIMI) flow in patients admitted to Chamran Hospital (Isfahan, Iran) with a diagnosis of STEMI during March-September, 2011. Subjects underwent PPCI if they had received eptifibatide. Rescue PCI was performed if patients had chest pain and/or persistent ST segment elevation despite receiving streptokinase (SK). Demographic characteristics, history of diseases, medicine, angiography findings, PCI type, and complications during the first 24 hours following PCI were collected. Data was then analyzed by Student's t-test, chi-square test, and logistic regression analysis.
A total number of 143 individuals, including 67 PPCI cases (46.9%) and 76 cases of rescue PCI (53.1%), were evaluated. The mean age of the participants was 58.92 ± 11.16 years old. Females constituted 18.2% (n = 26) of the whole population. No-reflow phenomenon was observed in 51 subjects (37.1%). Although 9 patients (6.3%) died during the first 24 hours after PCI, neither the crude nor the model adjusted for age and gender revealed significant relations between rescue PCI and death or no-reflow phenomenon. Rescue PCI and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, hyperlipidemia, coronary artery disease, smoking, platelets number, myocardial infarction level, the extent of stenosis, and the involved artery.
According to the present study, although SK is more effective than eptifibatide in resolution of thrombosis and clots, rescue PCI did not differ from PPCI in terms of the incidence of no-reflow phenomenon or short-term complications.
直接经皮冠状动脉介入治疗（PPCI）是ST段抬高型心肌梗死（STEMI）的首选治疗方法。然而，并非所有医院都具备所需设备。因此，由于时间紧迫，一些患者首先接受溶栓治疗。随后，出现胸痛和/或持续性ST段抬高的患者将接受补救性经皮冠状动脉介入治疗（PCI）。本研究评估并比较了接受PPCI或补救性PCI的患者PCI术后无复流现象的发生率及24小时并发症情况。
这项横断面研究评估了2011年3月至9月期间入住伊朗伊斯法罕Chamran医院且诊断为STEMI的患者的无复流现象、24小时并发症及心肌梗死溶栓（TIMI）血流情况。若患者接受了依替巴肽治疗，则接受PPCI。若患者尽管接受了链激酶（SK）治疗仍有胸痛和/或持续性ST段抬高，则进行补救性PCI。收集患者的人口统计学特征、疾病史、用药情况、血管造影结果、PCI类型以及PCI术后最初24小时内的并发症情况。然后采用学生t检验、卡方检验和逻辑回归分析对数据进行分析。
共评估了143例患者，其中包括67例PPCI病例（46.9%）和76例补救性PCI病例（53.1%）。参与者的平均年龄为58.92±11.16岁。女性占总人数的18.2%（n = 26）。51例患者（37.1%）出现无复流现象。尽管9例患者（6.3%）在PCI术后最初24小时内死亡，但无论是粗略分析还是对年龄和性别进行校正后的模型分析，均未显示补救性PCI与死亡或无复流现象之间存在显著关联。即使在对年龄、性别、糖尿病史、高血压、高脂血症、冠状动脉疾病、吸烟、血小板计数、心肌梗死程度、狭窄程度及受累血管进行校正后，补救性PCI与无复流现象之间也无显著相关性。
根据本研究，尽管SK在溶解血栓方面比依替巴肽更有效，但补救性PCI在无复流现象发生率或短期并发症方面与PPCI并无差异。
