Rathod Krishnaraj S, Hamshere Stephen, Khambata Rayomand S, Andiapen Mervyn, Westwood Mark, Mathur Anthony, Ahluwalia Amrita, Jones Daniel A
William Harvey Research Institute, Barts & The London Medical School, Queen Mary University of London, London, UK.
Department of Cardiology, Barts Health NHS Trust, London, UK.
JRSM Cardiovasc Dis. 2017 Aug 16;6:2048004017725988. doi: 10.1177/2048004017725988. eCollection 2017 Jan-Dec.
The local injection of novel cardioprotective study drugs prior to percutaneous coronary intervention could cause embolisation of thrombus, resulting in increased reperfusion injury and subsequent infarct size. The aim of this study was to assess the safety of the delivery of an intracoronary therapy delivered during primary percutaneous coronary intervention for acute myocardial infarction prior to the re-establishment of thrombolysis in myocardial infarction III flow.
One hundred sixty-seven patients with acute myocardial infarction successfully reperfused through primary percutaneous coronary intervention and undergoing Cardiac MRI within the first week after reperfusion were studied. Patients either underwent the delivery of an intracoronary agent (IMP or placebo) prior to balloon dilatation ( = 80) or standard primary percutaneous coronary intervention procedure ( = 117).
Baseline characteristics were similar between the two groups. There were a similar number of successful procedures (IC IMP 75 (93.8%) vs. No IMP 114, (97.4%), = 0.374), rates of no-reflow (IC IMP 1 (1.3%) vs. No IMP 2 (1.7%), = 0.99) and levels of ST segment resolution (88.5% IC IMP vs. No IC IMP 87.0%, = 0.669) between the two groups. Similar levels of microvascular obstruction were seen between the two groups with a trend to reduced infarct size, and improved ejection fractions in the IMP group. Lower MACE rates were seen in the IMP group.
The local intracoronary infusion of potential cardioprotective agents prior to the restoration of TIMI flow in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction appears to be safe and does not increase microvascular damage. This route should be considered when testing novel cardioprotective agents.
在经皮冠状动脉介入治疗前局部注射新型心脏保护研究药物可能导致血栓栓塞，从而增加再灌注损伤及随后的梗死面积。本研究的目的是评估在急性心肌梗死的直接经皮冠状动脉介入治疗期间，在恢复心肌梗死溶栓III级血流之前进行冠状动脉内治疗的安全性。
研究了167例通过直接经皮冠状动脉介入治疗成功再灌注并在再灌注后第一周内接受心脏磁共振成像的急性心肌梗死患者。患者在球囊扩张前接受冠状动脉内药物注射（IMP或安慰剂）（n = 80）或标准直接经皮冠状动脉介入治疗程序（n = 117）。
两组的基线特征相似。两组的成功手术数量相似（冠状动脉内注射IMP组75例（93.8%） vs. 未注射IMP组114例（97.4%），P = 0.374），无复流发生率相似（冠状动脉内注射IMP组1例（1.3%） vs. 未注射IMP组2例（1.7%），P = 0.99），ST段回落水平相似（冠状动脉内注射IMP组为88.5% vs. 未注射冠状动脉内IMP组为87.0%，P = 0.669）。两组的微血管阻塞水平相似，但IMP组有梗死面积减小和射血分数改善的趋势。IMP组的主要不良心血管事件发生率较低。
在接受急性心肌梗死直接经皮冠状动脉介入治疗的患者中，在恢复TIMI血流之前局部冠状动脉内输注潜在的心脏保护药物似乎是安全的，并且不会增加微血管损伤。在测试新型心脏保护药物时应考虑这种给药途径。
