罪犯冠状动脉中的基质金属蛋白酶-9与心肌无复流

Matrix Metalloproteinase-9 in the Culprit Coronary Artery and Myocardial No-Reflow.

作者信息

Dong Mei, Mu Nan, Ren Faxin, Li Fengli, Zhang Chuanhuan, Yang Jun

机构信息

Departments of Cardiology (MD, FR, FL, CZ, JY), and Gynecology (NM), Yantai Yuhuangding Hospital, Yantai City, China.

出版信息

Am J Med Sci. 2015 Nov;350(5):352-6. doi: 10.1097/MAJ.0000000000000559.

DOI:10.1097/MAJ.0000000000000559

PMID:26359995

Abstract

BACKGROUND

Matrix Metalloproteinases (MMPs) have been implicated in the pathogenesis of acute myocardial infarction (AMI). However, little is known about the association between MMP-9 and myocardial no-reflow. The aim of this study was to evaluate the role of MMP-9 in the culprit coronary artery as a predictor of no-reflow in patients with ST-elevation AMI.

METHODS

Ninety patients with ST-elevation AMI who underwent emergency percutaneous coronary intervention were consecutively recruited in this study. Blood samples were obtained from the extraction catheter placed distal to the culprit lesion at the beginning of percutaneous coronary intervention. No-reflow was defined as a coronary thrombolysis in myocardial infarction flow grade ≤2 after vessel reopening or thrombolysis in myocardial infarction flow 3 with a final myocardial blush grade ≤2.

RESULTS

No-reflow was observed in 25 patients (27.8%). Using multiple logistic regression analysis, local MMP-9 levels (odds ratio [OR] = 3.356; confidence interval [CI]: 1.441-5.881; P = 0.007) were found to be a significant risk factor of no-reflow together with lesion length (OR = 6.985; CI: 2.574-11.533; P = 0.009) and time to balloon (OR = 2.143; CI: 1.216-5.901; P = 0.042).

CONCLUSIONS

Elevation of MMP-9 level in the culprit coronary artery may predict no-reflow in patients with ST-elevation AMI.

摘要

背景

基质金属蛋白酶（MMPs）与急性心肌梗死（AMI）的发病机制有关。然而，关于MMP-9与心肌无复流之间的关联知之甚少。本研究的目的是评估MMP-9在罪犯冠状动脉中作为ST段抬高型AMI患者无复流预测指标的作用。

方法

本研究连续纳入了90例行急诊经皮冠状动脉介入治疗的ST段抬高型AMI患者。在经皮冠状动脉介入治疗开始时，从置于罪犯病变远端的抽吸导管获取血样。无复流定义为血管再通后心肌梗死溶栓血流分级≤2级，或心肌梗死溶栓血流3级且最终心肌灌注分级≤2级。

结果

25例患者（27.8%）出现无复流。通过多因素logistic回归分析发现，局部MMP-9水平（比值比[OR]=3.356；置信区间[CI]：1.441 - 5.881；P = 0.007）与病变长度（OR = 6.985；CI：2.574 - 11.533；P = 0.009）和球囊扩张时间（OR = 2.143；CI：1.216 - 5.901；P = 0.042）一起是无复流的显著危险因素。