Sengottuvelu G, Ravi Sekar V
Senior Consultant Cardiologist, Department of Cardiology, Apollo Hospitals, Greams Lane, Chennai 600 006, India.
Indian Heart J. 2013 May-Jun;65(3):256-9. doi: 10.1016/j.ihj.2013.04.021. Epub 2013 Apr 12.
Despite restoration of epicardial flow during primary PCI in STEMI, microvascular obstruction may persist as a result of both atheromatous and thrombotic embolization and vasospasm. Compared with the systemic administration of IV pharmaco-therapies, highly localized administration of intracoronary pharmacotherapy may be associated with a several-hundred-fold increase in the local concentration of an agent in the epicardial artery and microcirculation. Despite restoration of epicardial flow during primary PCI in STEMI, microvascular obstruction may persist as a result of both atheromatous and thrombotic embolization and vasospasm. We are presenting our experience with use of intracoronary abciximab using local drug delivery catheter in STEMI patients.
We retrospectively evaluated 15 patients presented to us with STEMI undergoing primary PCI between March 2011 and September 2012 who had super selective intracoronary abciximab using local drug delivery catheter. With standard antiplatelet therapy, both Pre and Post TIMI flow, TMP grading were assessed.
Mean age was 55 years. The TIMI flow increased by 3 grades in thirteen patients, TMP grading increased by 2 grades in five patients and by 3 grades in nine patients. Thus TIMI flow and TMP grading improved after super selective intracoronary abciximab.
Super selective intracoronary abciximab using local drug delivery catheter during primary PCI in STEMI patients significantly improves TMP grading without increased risk of bleeding. This benefit is achieved even in patients without thrombus aspiration. We need to assess the long-term outcomes in the form of reduction in infarct size using this strategy in large group of patients.
尽管在ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）时已恢复心外膜血流，但由于动脉粥样硬化和血栓栓塞以及血管痉挛，微血管阻塞可能仍然存在。与静脉内药物治疗的全身给药相比，冠状动脉内药物治疗的高度局部给药可能使心外膜动脉和微循环中药物的局部浓度增加数百倍。尽管在STEMI患者行直接PCI时已恢复心外膜血流，但由于动脉粥样硬化和血栓栓塞以及血管痉挛，微血管阻塞可能仍然存在。我们在此介绍我们在STEMI患者中使用局部给药导管行冠状动脉内阿昔单抗的经验。
我们回顾性评估了2011年3月至2012年9月期间15例因STEMI前来接受直接PCI的患者，这些患者使用局部给药导管进行了超选择性冠状动脉内阿昔单抗治疗。采用标准抗血小板治疗，评估TIMI血流分级和心肌灌注分级（TMP）的术前和术后情况。
平均年龄为55岁。13例患者的TIMI血流分级提高了3级，5例患者的TMP分级提高了2级，9例患者的TMP分级提高了3级。因此，超选择性冠状动脉内阿昔单抗治疗后TIMI血流分级和TMP分级得到改善。
在STEMI患者直接PCI期间使用局部给药导管进行超选择性冠状动脉内阿昔单抗治疗可显著改善TMP分级，且不增加出血风险。即使在未进行血栓抽吸的患者中也能获得这一益处。我们需要在大量患者中评估使用该策略以减少梗死面积形式的长期预后。
