梗死前心绞痛和冠状动脉侧支血流对ST段抬高型心肌梗死患者远程缺血预处理疗效的影响：一项随机对照试验的事后亚组分析
Influence of preinfarction angina and coronary collateral blood flow on the efficacy of remote ischaemic conditioning in patients with ST segment elevation myocardial infarction: post hoc subgroup analysis of a randomised controlled trial.
作者信息
Pryds Kasper, Bøttcher Morten, Sloth Astrid Drivsholm, Munk Kim, Rahbek Schmidt Michael, Bøtker Hans Erik
机构信息
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
出版信息
BMJ Open. 2016 Nov 24;6(11):e013314. doi: 10.1136/bmjopen-2016-013314.
OBJECTIVES
Remote ischaemic conditioning (RIC) confers cardioprotection in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). We investigated whether preinfarction angina and coronary collateral blood flow (CCBF) to the infarct-related artery modify the efficacy of RIC.
DESIGN
Post hoc subgroup analysis of a randomised controlled trial.
PARTICIPANTS
A total of 139 patients with STEMI randomised to treatment with pPCI or RIC+pPCI.
INTERVENTIONS
RIC was performed prior to pPCI as four cycles of 5 min upper arm ischaemia and reperfusion with a blood pressure cuff.
PRIMARY OUTCOME MEASURE
Myocardial salvage index (MSI) assessed by single-photon emission computerised tomography. We evaluated the efficacy of RIC in subgroups of patients with or without preinfarction angina or CCBF.
RESULTS
Of 139 patients included in the study, 109 had available data for preinfarction angina status and 54 had preinfarction angina. Among 83 patients with Thrombolysis In Myocardial Infarction flow 0/1 on arrival, 43 had CCBF. Overall, RIC+pPCI increased median MSI compared with pPCI alone (0.75 vs 0.56, p=0.045). Mean MSI did not differ between patients with and without preinfarction angina in either the pPCI alone (0.58 and 0.57; 95% CI -0.17 to 0.19, p=0.94) or the RIC+pPCI group (0.66 and 0.69; 95% CI -0.18 to 0.10, p=0.58). Mean MSI did not differ between patients with and without CCBF in the pPCI alone group (0.51 and 0.55; 95% CI -0.20 to 0.13, p=0.64), but was increased in patients with CCBF versus without CCBF in the RIC+pPCI group (0.75 vs 0.58; 95% CI 0.03 to 0.31, p=0.02; effect modification from CCBF on the effect of RIC on MSI, p=0.06).
CONCLUSIONS
Preinfarction angina did not modify the efficacy of RIC in patients with STEMI undergoing pPCI. CCBF to the infarct-related artery seems to be of importance for the cardioprotective efficacy of RIC.
TRIAL REGISTRATION NUMBER
NCT00435266, Post-results.
目的
远程缺血预处理（RIC）可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）患者起到心脏保护作用。我们研究了梗死前心绞痛和梗死相关动脉的冠状动脉侧支血流（CCBF）是否会改变RIC的疗效。
设计
一项随机对照试验的事后亚组分析。
参与者
共有139例STEMI患者被随机分配接受pPCI治疗或RIC + pPCI治疗。
干预措施
在pPCI之前进行RIC，通过血压袖带进行4个周期的上臂缺血5分钟及再灌注。
主要结局指标
通过单光子发射计算机断层扫描评估心肌挽救指数（MSI）。我们评估了RIC在有或没有梗死前心绞痛或CCBF的患者亚组中的疗效。
结果
在纳入研究的139例患者中，109例有梗死前心绞痛状态的可用数据，54例有梗死前心绞痛。在83例入院时心肌梗死溶栓血流为0/1级的患者中，43例有CCBF。总体而言，与单独使用pPCI相比，RIC + pPCI使MSI中位数增加（0.75对0.56，p = 0.045）。在单独使用pPCI组（0.58和0.57；95%可信区间-0.17至0.19，p = 0.94）或RIC + pPCI组（0.66和0.69；95%可信区间-0.18至0.10，p = 0.58）中，有或没有梗死前心绞痛的患者之间平均MSI无差异。在单独使用pPCI组中，有或没有CCBF的患者之间平均MSI无差异（0.51和0.55；95%可信区间-0.20至0.13，p = 0.64），但在RIC + pPCI组中，有CCBF的患者与没有CCBF的患者相比，平均MSI增加（0.75对0.58；95%可信区间0.03至0.31，p = 0.02；CCBF对RIC对MSI影响的效应修正，p = 0.06）。
结论
梗死前心绞痛并未改变接受pPCI的STEMI患者中RIC的疗效。梗死相关动脉的CCBF似乎对RIC的心脏保护疗效很重要。
试验注册号
NCT00435266，结果公布后。
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