Chen Wei Ren, Tian Feng, Chen Yun Dai, Wang Jing, Yang Jun Jie, Wang Zhi Feng, Da Wang Jin, Ning Qing Xiu
Department of Cardiology, PLA General Hospital, at Beijing, China.
Department of Cardiology, PLA General Hospital, at Beijing, China.
Int J Cardiol. 2016 Apr 1;208:109-14. doi: 10.1016/j.ijcard.2015.12.009. Epub 2015 Dec 15.
The 'no-reflow' phenomenon after a percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is a strong predictor of both short- and long-term mortality. Glucagon-like peptide-1 (GLP-1) exerts a cardioprotective effect during ischemia reperfusion injury. We planned to evaluate the effects of liraglutide on myocardial no-reflow after PCI for STEMI.
A total of 284 patients with STEMI undergoing PCI were enrolled in this study between September 2013 and March 2015. Of these, 210 patients were randomized 1:1 to receive either liraglutide or placebo 30 min before PCI (1.8 mg).
The primary end point, the prevalence of no-reflow, was significantly lower in the liraglutide group than in the control group (5% vs. 15%, P=0.01). Administration of liraglutide was consistently identified as a significant determinant for no-reflow ratio. There was a significant decrease in serum high-sensitivity C-reactive protein levels at 6-hour reperfusion in the liraglutide group compared to the control group (0.87 ± 0.09 mg/dL vs. 0.96 ± 0.10mg/dL, P<0.001). During a 3-month follow-up period, no difference was observed in the incidence of major adverse cardiovascular event.
Liraglutide may be associated with less no-reflow in STEMI, which should be confirmed by larger-scale trials.
急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后出现的“无复流”现象是短期和长期死亡率的有力预测指标。胰高血糖素样肽-1（GLP-1）在缺血再灌注损伤期间发挥心脏保护作用。我们计划评估利拉鲁肽对STEMI患者PCI术后心肌无复流的影响。
2013年9月至2015年3月期间，共有284例接受PCI的STEMI患者纳入本研究。其中，210例患者按1:1随机分组，在PCI术前30分钟接受利拉鲁肽（1.8mg）或安慰剂治疗。
主要终点，即无复流的发生率，利拉鲁肽组显著低于对照组（5%对15%，P=0.01）。利拉鲁肽的使用一直被确定为无复流率的重要决定因素。与对照组相比，利拉鲁肽组在再灌注6小时时血清高敏C反应蛋白水平显著降低（0.87±0.09mg/dL对0.96±0.10mg/dL，P<0.001）。在3个月的随访期内，主要不良心血管事件的发生率未观察到差异。
利拉鲁肽可能与STEMI患者较少的无复流相关，这一点应通过大规模试验予以证实。
