Department of Cardiology, St Vincent's Hospital, Fitzroy, Australia; Department of Medicine, University of Melbourne, Australia.
Int J Cardiol. 2013 Oct 30;169(2):121-5. doi: 10.1016/j.ijcard.2013.08.092. Epub 2013 Sep 13.
BACKGROUND/OBJECTIVES: We performed a prospective study to investigate markers of percutaneous coronary intervention (PCI) related microvascular injury.
Consecutive patients undergoing PCI for stable angina were studied. The index of microvascular resistance (IMR) was measured using a temperature and pressure sensing guidewire (TPSG) before and after single vessel PCI. Basal transit-time (TmnBase), that reflected non-hyperemic blood flow was also measured. Fasting bloods were taken to measure blood sugar, HbA1c and lipids. Asymmetric dimethylarginine (ADMA) was also measured as a marker of systemic endothelial function.
55 patients were included in the study. Mean age was 59.9 ± 11.2, 74.1% male. There was no significant difference in IMR post PCI compared with pre PCI values (IMR pre PCI = 16.96 [11.5,25.38] vs. IMR post PCI 14.2 [10.37,26.25] p = 0.96). IMR post PCI was higher in diabetic (DM) patients compared with non-diabetics [IMR post DM = 22.72 (13.35,42.91) vs. no DM = 13.9 (10.18,21.45), p = 0.02]. Fasting blood sugar, HbA1c and IMR pre PCI were correlated with post PCI IMR. IMR pre PCI, HbA1C and fasting glucose were higher in patients who developed PCI related microvascular dysfunction. The strongest independent predictor of post PCI IMR was the pre PCI IMR.
The baseline status of the microcirculation is an important determinant of post PCI microvascular function. Diabetics appear to have higher post PCI IMR.
背景/目的：我们进行了一项前瞻性研究，以探讨经皮冠状动脉介入治疗（PCI）相关微血管损伤的标志物。
连续纳入因稳定型心绞痛而行 PCI 的患者。在单支血管 PCI 前后，使用温度和压力感应导丝（TPSG）测量微血管阻力指数（IMR）。还测量了反映非充血性血流的基础传输时间（TmnBase）。空腹采血测量血糖、HbA1c 和血脂。同时测量非对称二甲基精氨酸（ADMA）作为全身内皮功能的标志物。
本研究共纳入 55 例患者。平均年龄为 59.9±11.2 岁，74.1%为男性。PCI 后 IMR 与 PCI 前相比无显著差异（IMR 前 PCI = 16.96 [11.5，25.38] vs. IMR 后 PCI = 14.2 [10.37，26.25]，p = 0.96）。与非糖尿病患者相比，糖尿病（DM）患者 PCI 后 IMR 更高[IMR 后 DM = 22.72（13.35，42.91）vs. 无 DM = 13.9（10.18，21.45），p = 0.02]。PCI 前空腹血糖、HbA1c 和 IMR 与 PCI 后 IMR 相关。发生 PCI 相关微血管功能障碍的患者 IMR 前 PCI、HbA1C 和空腹血糖更高。PCI 后 IMR 的最强独立预测因子是 PCI 前 IMR。
微循环的基线状态是 PCI 后微血管功能的重要决定因素。糖尿病患者 PCI 后 IMR 似乎更高。
