Dong Mei, Mu Nan, Guo Fangming, Zhang Chuanhuan, Ren Faxin, Li Jianping, Tao Zhigang, Yang Jun, Li Guangping
Department of Cardiology, Yuhuangding Hospital, 20 Yuhuangding, ZhiFu District, Yantai, 264000, Shan Dong, People's Republic of China.
J Thromb Thrombolysis. 2014;38(2):208-14. doi: 10.1007/s11239-013-1010-0.
No-reflow phenomenon is a serious complication of percutaneous coronary intervention (PCI) which is closely related to the incidence of major adverse cardiovascular events. It has been demonstrated that Postconditioning (PostC) during primary PCI confers protection against ischemia-reperfusion injury and thus might reduce infarct size. However, whether PostC may exert its beneficial effects on acute myocardial infarction (AMI) patients by reducing no-reflow phenomenon is still unknown. Sixty two patients diagnosed with ST-elevation AMI were randomly assigned to study group (n = 32) or control group (n = 30). Blood samples were obtained and assayed for creatine kinase MB (CK-MB) and high-sensitive C-reactive protein (hs-CRP). Determinants of reflow, including final thrombolysis in myocardial infarction (TIMI) grade-3 flow, ST-segment resolution (STR), myocardial blush grades-3 (MBG-3) and corrected thrombolysis in myocardial infarction frame count (cTFC), were comparative between the two groups. Compared with control group, more patients in study group were identified as the final TIMI grade-3 flow (81.3 vs. 56.7%, P = 0.036), MBG-3 (23 vs. 14%, P = 0.043) and STR ≥50% (93.8 vs. 73.3%, P = 0.029), while patients in study group had less cTFC (28.5 ± 9.1 vs. 37.4 ± 12.4, P = 0.002) After PCI, study group was associated with lower levels of CK-MB (2,397.6 ± 470.2 vs. 2,159.9 ± 485.5, P = 0.028), Troponin-I (197.5 ± 32.5 vs. 154 ± 43.1, P = 0.041) and hs-CRP (5.5 ± 4.5 vs. 9.5 ± 5.2 mg/L, P = 0.019) in comparison with control group. Left ventricle ejection fraction was better in the study group than in the control group (55.1 ± 9.8 vs. 42.9 ± 10.7, P = 0.042). PostC could improve myocardial reperfusion in patients with ST-elevation AMI undergoing PCI by reducing no-reflow. However, due to the limited sample size, the results of our study should not be considered conclusive.
无复流现象是经皮冠状动脉介入治疗（PCI）的一种严重并发症，与主要不良心血管事件的发生率密切相关。已经证明，在直接PCI期间进行的后适应（PostC）可提供针对缺血再灌注损伤的保护，因此可能会减小梗死面积。然而，PostC是否可以通过减少无复流现象对急性心肌梗死（AMI）患者发挥有益作用仍不清楚。将62例诊断为ST段抬高型AMI的患者随机分为研究组（n = 32）或对照组（n = 30）。采集血样并检测肌酸激酶同工酶MB（CK-MB）和高敏C反应蛋白（hs-CRP）。比较两组之间复流的决定因素，包括心肌梗死溶栓治疗（TIMI）最终3级血流、ST段回落（STR）、心肌灌注分级3级（MBG-3）和校正的心肌梗死溶栓帧数（cTFC）。与对照组相比，研究组中更多患者被确定为TIMI最终3级血流（81.3%对56.7%，P = 0.036）、MBG-3（23%对14%，P = 0.043）和STR≥50%（93.8%对73.3%，P = 0.029），而研究组患者的cTFC较少（28.5±9.1对37.4±12.4，P = 0.002）。PCI后，与对照组相比，研究组的CK-MB（2397.6±470.2对2159.9±485.5，P = 0.028）、肌钙蛋白I（197.5±32.5对154±43.1，P = 0.041）和hs-CRP（5.5±4.5对9.5±5.2mg/L，P = 0.019）水平较低。研究组的左心室射血分数优于对照组（55.1±9.8对42.9±10.7，P = 0.042）。PostC可以通过减少无复流现象改善接受PCI的ST段抬高型AMI患者的心肌再灌注。然而，由于样本量有限，我们研究的结果不应被视为结论性的。
