Wang Y Y, Li T, Liu Y W, Liu B J, Hu X M, Wang Y, Gao W Q, Wu P, Huang L, Li X, Peng W J, Ning M
Key Laboratory for Artificial Cells of Tianjin, Artificial Cell Engineering Technology Research Center of Ministry of Health, Department of Cardiac Center, Third Central Hospital of Tianjin, Tianjin 300170, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Apr 24;45(4):277-282. doi: 10.3760/cma.j.issn.0253-3758.2017.04.005.
To evaluate the effect of the ischemic post-conditioning (IPC) on the prevention of the cardio-renal damage in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). A total of 251 consecutive STEMI patients underwent PPCI in the heart center of Tianjin Third Central Hospital from January 2012 to June 2014 were enrolled in this prospective, randomized, control, single-blinded, clinical registry study. Patients were randomly divided into IPC group (123 cases) and control group (128 cases) with random number table. Patients in IPC group underwent three times of inflation/deflation with low inflation pressure using a balloon catheter within one minute after culprit vessel blood recovery, and then treated by PPCI. Patients in control group received PPCI procedure directly. The basic clinical characteristics, incidence of reperfusion arrhythmia during the procedure, the rate of electrocardiogram ST-segment decline, peak value of myocardial necrosis markers, incidence of contrast induced acute kidney injury(CI-AKI), and one-year major adverse cardiovascular events(MACE) which including myocardial infarction again, malignant arrhythmia, rehospitalization for heart failure, repeat revascularization, stroke, and death after the procedure were analyzed between the two groups. The age of IPC group and control group were comparable((61.2±12.6) vs. (64.2±12.1) years old, =0.768). The incidence of reperfusion arrhythmia during the procedure was significantly lower in the IPC group than in the control group(42.28% (52/123) vs. 57.03% (73/128), =0.023). The rate of electrocardiogram ST-segment decline immediately after the procedure was significantly higher in the IPC group than in the control group (77.24% (95/123) vs. 64.84% (83/128), =0.037). The peak value of myocardial necrosis markers after the procedure were significantly lower in the IPC group than in the control group(creatine kinase: 1 257 (682, 2 202) U/L vs. 1 737(794, 2 816)U/L, =0.029; creatine kinase-MB: 123(75, 218)U/L vs.165(95, 288)U/L, =0.010). The rate of CI-AKI after the procedure was significantly lower in the IPC group than in the control group(5.69%(7/123) vs. 14.06%(18/128), =0.034). The rate of the one-year MACE was significantly lower in the IPC group than in the control group(7.32%(9/123) vs. 15.63% (20/128), =0.040). The IPC strategy performed eight before PPCI can reduce myocardial ischemia- reperfusion injury, decline the rates of CI-AKI and one-year MACE significantly in STEMI patients, thus has a significant protective effect on heart and kidney in STEMI patients. Clinical Trial Registration Chinese Clinical Trials Registry, ChiCTR-ICR-15006590.
评估缺血后适应（IPC）对急性ST段抬高型心肌梗死（STEMI）患者在直接经皮冠状动脉介入治疗（PPCI）后预防心肾损伤的效果。选取2012年1月至2014年6月在天津市第三中心医院心脏中心连续接受PPCI的251例STEMI患者，纳入这项前瞻性、随机、对照、单盲临床注册研究。采用随机数字表法将患者随机分为IPC组（123例）和对照组（128例）。IPC组患者在罪犯血管血流恢复后1分钟内使用球囊导管以低充气压力进行3次充气/放气，然后接受PPCI治疗。对照组患者直接接受PPCI手术。分析两组患者的基本临床特征、术中再灌注心律失常发生率、心电图ST段下降率、心肌坏死标志物峰值、对比剂诱导的急性肾损伤（CI-AKI）发生率以及术后1年主要不良心血管事件（MACE），包括再次心肌梗死、恶性心律失常、因心力衰竭再次住院、重复血运重建、卒中及死亡情况。IPC组和对照组患者年龄相当（（61.2±12.6）岁 vs.（64.2±12.1）岁，P =0.768）。IPC组术中再灌注心律失常发生率显著低于对照组（42.28%（52/123） vs. 57.03%（73/128），P =0.023）。术后即刻IPC组心电图ST段下降率显著高于对照组（77.24%（95/123） vs. 64.84%（83/128），P =0.037）。术后IPC组心肌坏死标志物峰值显著低于对照组（肌酸激酶：1257（682，2202）U/L vs. 1737（794，2816）U/L，P =0.029；肌酸激酶同工酶：123（75，218）U/L vs. 165（95，288）U/L，P =0.010）。术后IPC组CI-AKI发生率显著低于对照组（5.69%（7/123） vs. 14.06%（18/。128），P =0.034）。IPC组术后1年MACE发生率显著低于对照组（7.32%（9/123） vs. 15.63%（20/128），P =0.040）。PPCI前实施8次的IPC策略可减轻STEMI患者心肌缺血-再灌注损伤，显著降低CI-AKI发生率及术后1年MACE发生率，从而对STEMI患者的心肾具有显著保护作用。临床试验注册号：中国临床试验注册中心，ChiCTR-ICR-15006590。
