Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy; SC Cardiologia, Azienda Sanitaria Locale 3 Ospedale Villa Scassi, Genova, Italy.
JACC Cardiovasc Interv. 2013 Oct;6(10):1055-63. doi: 10.1016/j.jcin.2013.05.011.
This study sought to evaluate whether remote ischemic post-conditioning (RIPC) could reduce enzymatic infarct size in patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI).
Myocardial reperfusion injury may attenuate the benefit of pPCI. In animal models, RIPC mitigates myocardial reperfusion injury.
One hundred patients with anterior ST-segment elevation myocardial infarction and occluded left anterior descending artery were randomized to pPCI + RIPC (n = 50) or conventional pPCI (n = 50). RIPC consisted of 3 cycles of 5 min/5 min ischemia/reperfusion by cuff inflation/deflation of the lower limb. The primary endpoint was infarct size assessed by the area under the curve of creatinine kinase-myocardial band release (CK-MB). Secondary endpoints included the following: infarct size assessed by cardiac magnetic resonance delayed enhancement volume; T2-weighted edema volume; ST-segment resolution >50%; TIMI (Thrombolysis In Myocardial Infarction) frame count; and myocardial blush grading.
Four patients (2 RIPC, 2 controls) were excluded due to missing samples of CK-MB. A total of 96 patients were analyzed; median area under the curve CK-MB was 8,814 (interquartile range [IQR]: 5,567 to 11,325) arbitrary units in the RIPC group and 10,065 (IQR: 7,465 to 14,004) arbitrary units in control subjects (relative reduction: 20%, 95% confidence interval: 0.2% to 28.7%; p = 0.043). Seventy-seven patients underwent a cardiac magnetic resonance scan 3 to 5 days after randomization, and 66 patients repeated a second scan after 4 months. T2-weighted edema volume was 37 ± 16 cc in RIPC patients and 47 ± 22 cc in control subjects (p = 0.049). ST-segment resolution >50% was 66% in RIPC and 37% in control subjects (p = 0.015). We observed no significant differences in TIMI frame count, myocardial blush grading, and delayed enhancement volume.
In patients with anterior ST-segment elevation myocardial infarction, RIPC at the time of pPCI reduced enzymatic infarct size and was also associated with an improvement of T2-weighted edema volume and ST-segment resolution >50%. (Remote Postconditioning in Patients With Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention [PCI] [RemPostCon]; NCT00865722).
本研究旨在评估远程缺血后处理（RIPC）是否能减少接受直接经皮冠状动脉介入治疗（pPCI）的前壁 ST 段抬高型心肌梗死患者的酶性梗死面积。
心肌再灌注损伤可能会减弱 pPCI 的获益。在动物模型中，RIPC 减轻了心肌再灌注损伤。
100 例前壁 ST 段抬高型心肌梗死且前降支闭塞的患者随机分为 pPCI+RIPC 组（n=50）或常规 pPCI 组（n=50）。RIPC 由通过充气/放气袖带对下肢进行 3 个周期的 5 分钟/5 分钟缺血/再灌注组成。主要终点是通过肌酸激酶-MB 释放的曲线下面积评估的梗死面积（CK-MB）。次要终点包括：通过心脏磁共振延迟增强体积评估的梗死面积；T2 加权水肿体积；ST 段缓解>50%；TIMI（血栓溶解治疗心肌梗死）帧数；以及心肌灌注分级。
由于 CK-MB 样本缺失，4 例患者（2 例 RIPC，2 例对照组）被排除。共分析了 96 例患者；RIPC 组 CK-MB 的中位数曲线下面积为 8814（四分位距[IQR]：5567 至 11325）个单位，对照组为 10065（IQR：7465 至 14004）个单位（相对减少：20%，95%置信区间：0.2%至 28.7%；p=0.043）。77 例患者在随机分组后 3 至 5 天进行了心脏磁共振扫描，66 例患者在 4 个月后重复了第二次扫描。RIPC 患者的 T2 加权水肿体积为 37±16cc，对照组为 47±22cc（p=0.049）。RIPC 组 ST 段缓解>50%的比例为 66%，对照组为 37%（p=0.015）。我们没有观察到 TIMI 帧数、心肌灌注分级和延迟增强体积的显著差异。
在前壁 ST 段抬高型心肌梗死患者中，pPCI 时的 RIPC 减少了酶性梗死面积，并且还与 T2 加权水肿体积和 ST 段缓解>50%的改善相关。（直接经皮冠状动脉介入治疗治疗的急性心肌梗死患者的远程后处理[PCI] [RemPostCon]；NCT00865722）。
