Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
Am J Cardiol. 2013 Oct 1;112(7):911-7. doi: 10.1016/j.amjcard.2013.05.021. Epub 2013 Jun 14.
The goal of this study was to characterize determinants of infarct size in the multicenter randomized Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP-AMI) trial. Contemporary determinants of infarct size in patients presenting with acute anterior myocardial infarction without shock and undergoing percutaneous revascularization have been incompletely characterized. In CRISP-AMI, 337 patients with acute anterior ST segment elevation myocardial infarction but without cardiogenic shock at 30 sites in 9 countries were randomized to initiation of intra-aortic balloon counterpulsation before primary percutaneous coronary intervention versus standard of care. The primary outcome was infarct size as measured by cardiac magnetic resonance imaging 3 to 5 days after percutaneous coronary intervention. Of 337 randomized patients, complete periprocedural and infarct size data were available in 250 patients (74%). After a comparison of baseline characteristics to ensure no significant differences, patients with missing data were excluded. Using multiple linear regression of 23 variables, time from symptom onset to first device (β = 0.022, p = 0.047) and preprocedural Thrombolysis In Myocardial Infarction flow 0/1 (β = 15.28, p <0.001) were independent predictors of infarct size. Infarct size increased by 0.43% per 30 minutes in early reperfusion and by 0.63% every 30 minutes in late reperfusion. In conclusion, in patients with acute anterior ST elevation myocardial infraction without cardiogenic shock, total ischemic time and preprocedural Thrombolysis In Myocardial Infarction flow 0/1 were associated with increased infarct size as determined by cardiac magnetic resonance imaging. These findings underscore the importance of systems of care aimed at reducing total ischemic time to open infarct arteries.
本研究旨在对多中心随机对照反搏减少经皮冠状动脉介入治疗前急性心肌梗死（CRISP-AMI）试验中的梗死面积决定因素进行分析。目前对无休克的急性前壁心肌梗死患者行经皮冠状动脉血运重建时梗死面积的当代决定因素的认识尚不全面。在 CRISP-AMI 研究中，337 例急性前壁 ST 段抬高型心肌梗死患者在 9 个国家的 30 个中心入选，随机分为主动脉内球囊反搏治疗组和标准治疗组，在直接经皮冠状动脉介入治疗前开始治疗。主要转归为经皮冠状动脉介入治疗后 3-5 天心脏磁共振成像检测的梗死面积。337 例随机患者中，250 例（74%）患者有完整的围术期和梗死面积数据。在对基线特征进行比较以确保无显著差异后，排除了缺失数据的患者。对 23 个变量进行多元线性回归分析，结果显示从症状发作到首次应用器械的时间（β=0.022，p=0.047）和术前心肌梗死溶栓血流分级 0/1（β=15.28，p＜0.001）是梗死面积的独立预测因素。早期再灌注时，每 30 分钟梗死面积增加 0.43%，晚期再灌注时每 30 分钟增加 0.63%。结论：在无休克的急性前壁 ST 段抬高型心肌梗死患者中，总缺血时间和术前心肌梗死溶栓血流分级 0/1 与心脏磁共振成像确定的梗死面积增大相关。这些发现强调了旨在减少开放梗死动脉的总缺血时间的医疗护理体系的重要性。
