ST段抬高型心肌梗死患者的远程缺血预处理与医疗系统延迟

Remote ischaemic conditioning and healthcare system delay in patients with ST-segment elevation myocardial infarction.

作者信息

Pryds Kasper, Terkelsen Christian Juhl, Sloth Astrid Drivsholm, Munk Kim, Nielsen Søren Steen, Schmidt Michael Rahbek, Bøtker Hans Erik

机构信息

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Heart. 2016 Jul 1;102(13):1023-8. doi: 10.1136/heartjnl-2015-308980. Epub 2016 Feb 24.

DOI:10.1136/heartjnl-2015-308980

PMID:26911520

Abstract

OBJECTIVE

We investigated influence of remote ischaemic conditioning (RIC) on the detrimental effect of healthcare system delay on myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

METHODS

A post-hoc analysis of a randomised controlled trial in patients with STEMI randomised to treatment with pPCI or RIC+pPCI. RIC was performed as four cycles of intermittent 5 min upper arm ischaemia and reperfusion. Healthcare system delay was defined as time from emergency medical service call to pPCI-wire. Myocardial salvage index (MSI) was assessed by single photon emission computerised tomography.

RESULTS

Data for healthcare system delay and MSI were available for 129 patients. MSI was negatively associated with healthcare system delay in patients treated with pPCI alone (-0.003 decrease in MSI/min of healthcare system delay; 95% CI -0.005 to -0.001, r(2)=0.11, p=0.008) but not in patients treated with RIC+pPCI (-0.0002 decrease in MSI/min of healthcare system delay; 95% CI -0.001 to 0.001, r(2)=0.002, p=0.74). In patients with healthcare system delay ≤120 min, RIC+pPCI did not affect median MSI compared with pPCI alone (0.75 (IQR: 0.49-0.99) and 0.70 (0.45-0.94), p=1.00). However, in patients with healthcare system delay >120 min, RIC+pPCI increased median MSI compared with pPCI alone (0.74 (0.52-0.93) vs 0.42 (0.22-0.68), p=0.02). Adjusting for potential confounders did not affect the results.

CONCLUSIONS

RIC as adjunctive to pPCI attenuated the detrimental effect of healthcare system delay on myocardial salvage in patients with STEMI, suggesting that the cardioprotective effect of RIC increases with the duration of ischaemia.

TRIAL REGISTRATION NUMBER

NCT00435266; post-results.

摘要

目的

我们研究了远程缺血预处理（RIC）对医疗系统延误对接受直接经皮冠状动脉介入治疗（pPCI）的ST段抬高型心肌梗死（STEMI）患者心肌挽救的不利影响。

方法

对一项随机对照试验进行事后分析，该试验将STEMI患者随机分为接受pPCI治疗或RIC + pPCI治疗。RIC通过四个周期的间歇性5分钟上臂缺血和再灌注来进行。医疗系统延误定义为从紧急医疗服务呼叫到pPCI导丝置入的时间。通过单光子发射计算机断层扫描评估心肌挽救指数（MSI）。

结果

129例患者有医疗系统延误和MSI的数据。在仅接受pPCI治疗的患者中，MSI与医疗系统延误呈负相关（医疗系统延误每增加1分钟，MSI降低0.003；95%可信区间为 -0.005至 -0.001，r(2)=0.11，p = 0.008），而在接受RIC + pPCI治疗的患者中则无此相关性（医疗系统延误每增加1分钟，MSI降低0.0002；95%可信区间为 -0.001至0.001，r(2)=0.002，p = 0.74）。在医疗系统延误≤120分钟的患者中，与仅接受pPCI治疗相比，RIC + pPCI对MSI中位数无影响（分别为0.75（四分位间距：0.49 - 0.99）和0.70（0.45 - 0.94），p = 1.00）。然而，在医疗系统延误>120分钟的患者中，与仅接受pPCI治疗相比，RIC + pPCI增加了MSI中位数（分别为0.74（0.52 - 0.93）和0.42（0.22 - 0.68），p = 0.02）。对潜在混杂因素进行校正后不影响结果。