血清尿酸水平升高会影响行直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者的心肌再灌注和梗死面积。

Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

机构信息

Division of Cardiology.

School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia.

出版信息

J Cardiovasc Med (Hagerstown). 2018 May;19(5):240-246. doi: 10.2459/JCM.0000000000000634.

DOI:10.2459/JCM.0000000000000634

PMID:29470249

Abstract

AIMS

Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention.

METHODS

We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality.

RESULTS

A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3 ± 22 vs. 29.1 ± 15 ml, P = 0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P = 0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3 ± 22.4 vs. 29.9 ± 15.4 ml, P = 0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2-weighted edema (53.8 vs. 41.2 ml, P = 0.031) and less favorable MBG (MBG < 2: 44.4 vs. 13.6%, P = 0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, all-cause mortality was higher in the eSUA group (18.8 vs. 2.4%, P = 0.028).

CONCLUSION

eSUA may affect myocardial reperfusion in patients with STEMI undergoing percutaneous coronary intervention and is associated with larger infarct size and higher long-term mortality.

摘要

目的

血清尿酸（eSUA）升高与 ST 段抬高型心肌梗死（STEMI）患者的不良预后相关。然而，eSUA 对心肌再灌注损伤和梗死面积的影响尚未得到充分研究。我们的目的是在接受直接经皮冠状动脉介入治疗的 STEMI 患者中，将 eSUA 与梗死面积、梗死面积缩小、心肌再灌注分级和长期死亡率相关联。

方法

我们对两项测试心肌缺血/再灌注损伤保护策略的随机对照试验进行了事后患者水平分析。每位患者均接受了急性（3-5 天）和随访（4-6 个月）心脏磁共振检查。梗死面积和梗死面积缩小是研究的主要结果。我们评估了 T2 加权水肿、心肌灌注分级（MBG）、校正的心肌梗死溶栓治疗帧数、ST 段回落和长期全因死亡率。

结果

共纳入 101 例（86.1%为前壁）STEMI 患者；其中 16 例（15.8%）患者存在 eSUA。与非 eSUA 患者相比，eSUA 患者的梗死面积更大（42.3±22 比 29.1±15 ml，P=0.008）。在校正了协变量后，eSUA 患者的梗死面积增加了 10.3 ml（95%置信区间为 1.2-19.3 ml，P=0.001）。在前壁心肌梗死患者中，两组间的延迟增强差异仍然存在（分别为 42.3±22.4 比 29.9±15.4 ml，P=0.015）。两组间的梗死面积缩小无显著差异。与非 eSUA 患者相比，eSUA 患者的 T2 加权水肿更大（53.8 比 41.2 ml，P=0.031），MBG 更差（MBG<2：44.4 比 13.6%，P=0.045）。校正的心肌梗死溶栓治疗帧数和 ST 段回落两组间无显著差异。在中位随访 7.3 年后，eSUA 组的全因死亡率更高（18.8%比 2.4%，P=0.028）。