Li J S, Zhao X J, Ma B X, Wang Z
Department of Cardiology, Binzhou Medical University Hospital, Binzhou, China.
J Biol Regul Homeost Agents. 2016 Jul-Sep;30(3):733-741.
Percutaneous coronary intervention (PCI) has been extensively applied to repair the forward flow of diseased coronary artery and can achieve significant curative results. However, some patients with acute myocardial infarction (AMI) develop non-perfusion or poor perfusion of cardiac muscle tissue after PCI, which increases the incidence of cardiovascular events and the death rate. PCI can dredge narrowed or infarct-related artery (IRA) and thus induce full reperfusion of ischemic myocardium. It is found in practice that some cases of AMI still have no perfusion or poor perfusion in myocardial tissue even though coronary angiography suggests opened coronary artery after PCI, which increases the incidence of vascular events and mortality. Therefore, to explore the detailed mechanism of PCI in treating coronary microcirculation of patients with stable angina pectoris, we selected 140 patients with stable angina pectoris for PCI, observing the index of microcirculatory resistance (IMR) of descending branch and changes of myocardial injury markers and left ventricular systolic function, and made a subgroup analysis based on the correlation between clinical indexes, IMR and other variables of diabetic and non-diabetic patients, PCI-related and non-PCI-related myocardial infarction patients. The results suggest that IMR of anterior descending branch after PCI was higher compared to that before PCI, and the difference was significant (P less than 0.05); creatine kinase-MB (CK-MB), myohemoglobin and high sensitive troponin T were all increased after PCI, and the difference was also significant (P less than 0.05); brain natriuretic peptide (BNP) level became higher after PCI, with significant difference (P less than 0.05); left ventricular ejection fraction (LVEF) declined after PCI, and the difference before and after PCI was statistically significant (P less than 0.05). Moreover, subgroup analysis results of the three groups all demonstrated statistically significant differences. PCI can effectively increase microcirculatory resistance of patients with stable angina pectoris, especially those who develop both stable angina pectoris and diabetes. Patients with higher microcirculatory resistance before PCI are more likely to develop PCI-related myocardial infarction after PCI.
经皮冠状动脉介入治疗（PCI）已被广泛应用于修复病变冠状动脉的前向血流，并能取得显著疗效。然而，一些急性心肌梗死（AMI）患者在PCI术后会出现心肌组织无灌注或灌注不良的情况，这增加了心血管事件的发生率和死亡率。PCI可疏通狭窄或梗死相关动脉（IRA），从而实现缺血心肌的完全再灌注。在实践中发现，即使冠状动脉造影显示PCI术后冠状动脉已开通，但仍有部分AMI病例心肌组织无灌注或灌注不良，这增加了血管事件的发生率和死亡率。因此，为探讨PCI治疗稳定型心绞痛患者冠状动脉微循环的详细机制，我们选取了140例稳定型心绞痛患者进行PCI治疗，观察其降支微循环阻力指数（IMR）、心肌损伤标志物及左心室收缩功能的变化，并根据糖尿病和非糖尿病患者、PCI相关和非PCI相关心肌梗死患者的临床指标、IMR及其他变量之间的相关性进行亚组分析。结果显示，PCI术后前降支的IMR高于术前，差异有统计学意义（P＜0.05）；PCI术后肌酸激酶同工酶（CK-MB）、肌红蛋白和高敏肌钙蛋白T均升高，差异也有统计学意义（P＜0.05）；PCI术后脑钠肽（BNP）水平升高，差异有统计学意义（P＜0.05）；PCI术后左心室射血分数（LVEF）下降，PCI前后差异有统计学意义（P＜0.05）。此外，三组的亚组分析结果均显示差异有统计学意义。PCI可有效增加稳定型心绞痛患者的微循环阻力，尤其是同时患有稳定型心绞痛和糖尿病的患者。PCI术前微循环阻力较高的患者在PCI术后更易发生PCI相关心肌梗死。
