Araszkiewicz Aleksander, Grygier Marek, Pyda Małgorzata, Rajewska Justyna, Lesiak Maciej, Grajek Stefan
1st Department of Cardiology, University of Medical Sciences, Poznan, Poland.
1st Department of Cardiology, University of Medical Sciences, Poznan, Poland.
J Cardiol. 2015 Jun;65(6):459-65. doi: 10.1016/j.jjcc.2015.02.010. Epub 2015 Mar 29.
It has been demonstrated that postconditioning (postcon), brief episodes of ischemia during reperfusion period, in patients with ST-segment elevation myocardial infarction (STEMI) confers protection against ischemia-reperfusion injury and as a result, postcon might reduce infarct size. However, whether postcon may exert its beneficial effect on STEMI patients by reducing the occurrence of early malignant ventricular arrhythmias (VA) is still unknown. The aim of the study was to evaluate the influence of postcon on the presence of VA in early presenters with high-risk STEMI treated with primary coronary intervention (PCI).
Seventy-five STEMI patients treated with primary PCI within 6h from symptoms onset were randomly assigned to postcon group (n=37) or conventional PCI group (n=38) in 1:1 ratio. Postcon was performed immediately after restoration of coronary flow as follows: the angioplasty balloon was inflated 4× 1min with low-pressure inflations, each separated by 1min of deflation. After that the patients were continuously monitored electrographically for 48h. The end-point of the study was the occurrence of VA (ventricular fibrillation-VF, sustained ventricular tachycardia-sVT, non-sustained ventricular tachycardia-nsVT) within 48h after the procedure.
In the postcon group, the occurrence of VAs was significantly lower: VF-3, sVT-0, nsVT-15, i.e. (18 patients - 48.6%) in comparison to control group: VF-2, sVT-4, nsVT-23 (29 patients - 76.3%); p=0.013. The occurrence of accelerated idioventricular rhythm varied insignificantly between both groups (postcon - 45.9% vs control - 34.2%; p=NS).
Postcon may reduce the occurrence of malignant VA in patients with STEMI treated with primary PCI.
已经证实，对于ST段抬高型心肌梗死（STEMI）患者，再灌注期短暂的缺血发作即后适应（postcon）可对缺血-再灌注损伤起到保护作用，因此，后适应可能会缩小梗死面积。然而，后适应是否可通过减少早期恶性室性心律失常（VA）的发生而对STEMI患者发挥有益作用仍不明确。本研究的目的是评估后适应对接受直接冠状动脉介入治疗（PCI）的高危STEMI早期患者室性心律失常发生情况的影响。
症状发作6小时内接受直接PCI治疗的75例STEMI患者按1:1比例随机分为后适应组（n=37）和传统PCI组（n=38）。冠状动脉血流恢复后立即进行后适应，具体如下：血管成形术球囊以低压充气4次，每次1分钟，每次充气后放气1分钟。之后对患者进行48小时的心电持续监测。研究终点为术后48小时内室性心律失常（心室颤动-VF、持续性室性心动过速-sVT、非持续性室性心动过速-nsVT）的发生情况。
后适应组室性心律失常的发生率显著低于对照组：VF-3例，sVT-0例，nsVT-15例，即18例患者（48.6%）；对照组：VF-2例，sVT-4例，nsVT-23例（29例患者-76.3%）；p=0.013。两组间加速性室性自主心律的发生率无显著差异（后适应组-45.9% vs对照组-34.2%；p=无统计学意义）。
后适应可降低接受直接PCI治疗的STEMI患者恶性室性心律失常的发生率。
