Ying Zhou, Jiansong Yuan, Yong Wang, Shubin Qiao
Department of Cardiology, China-Japan Friendship Hospital.
Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China.
Coron Artery Dis. 2019 Mar;30(2):103-108. doi: 10.1097/MCA.0000000000000702.
Spontaneous reperfusion (SR) was associated with significant myocardial salvage, decreased mortality rates, better clinical outcomes, and lower incidences of major adverse cardiovascular events. It was found that apelin inhibited thrombin-induced and collagen-induced platelet activation and aggregation. This study was carried out to assess whether serum apelin correlates with SR of the infarct-related coronary artery in ST-elevation myocardial infarction (STEMI) patients.
Blood samples were obtained on admission in 280 consecutive patients with STEMI before primary percutaneous coronary intervention. Blood chemistry and apelin levels were tested. Coronary arteriography and echocardiography were performed after admission.
Frequencies of the patients with preinfarct angina, history of smoking, and pathoglycemia were higher in the non-SR group than in the SR group (P=0.03, 0.001, and 0.002, respectively). Peak values of plasma troponin-I and frequencies of the patients with Killip 2-3 were significantly higher in the non-SR group (P<0.05, respectively) compared with the SR group. Left ventricular systolic and diastolic functions improved markedly in the SR group compared with the non-SR group. Gensini scores were lower in the SR group than the non-SR group (P=0.02). Serum apelin was significantly higher in patients with SR compared with patients with non-SR (0.82±0.34 vs. 0.35±0.22 ng/ml, P=0.04). A cut-off value of 0.75 ng/ml had a predictive value of 77% to identify patients with SR. In the non-SR group, patients who died in the hospital had much lower apelin levels compared with those who survived (P<0.001). Apelin level in the high thrombus load group was much lower compared with the other group (P<0.001). Apelin level in the group undergoing successful reperfusion was much higher than that in the group without successful reperfusion (P<0.001).
Patients with SR have better cardiac systolic function and improved diastolic function. An increased serum apelin level is an independent and novel predictor of SR for STEMI patients.
自发再灌注（SR）与显著的心肌挽救、降低死亡率、更好的临床结局以及更低的主要不良心血管事件发生率相关。研究发现，阿片肽可抑制凝血酶诱导和胶原诱导的血小板活化及聚集。本研究旨在评估ST段抬高型心肌梗死（STEMI）患者血清阿片肽水平与梗死相关冠状动脉自发再灌注之间是否存在关联。
对280例连续的STEMI患者在进行直接经皮冠状动脉介入治疗前入院时采集血样。检测血液生化指标及阿片肽水平。入院后进行冠状动脉造影和超声心动图检查。
非自发再灌注组患者梗死前心绞痛、吸烟史及血糖异常的发生率高于自发再灌注组（P分别为0.03、0.001和0.002）。与自发再灌注组相比，非自发再灌注组血浆肌钙蛋白I峰值及Killip 2 - 3级患者的频率显著更高（P均<0.05）。与非自发再灌注组相比，自发再灌注组左心室收缩和舒张功能明显改善。自发再灌注组的Gensini评分低于非自发再灌注组（P = 0.02）。自发再灌注患者的血清阿片肽水平显著高于非自发再灌注患者（0.82±0.34 vs. 0.35±0.22 ng/ml，P = 0.04）。0.75 ng/ml的截断值识别自发再灌注患者的预测价值为77%。在非自发再灌注组中，院内死亡患者的阿片肽水平远低于存活患者（P<0.001）。高血栓负荷组的阿片肽水平远低于另一组（P<0.001）。成功再灌注组的阿片肽水平远高于未成功再灌注组（P<0.001）。
自发再灌注患者具有更好的心脏收缩功能和改善的舒张功能。血清阿片肽水平升高是STEMI患者自发再灌注的独立且新的预测指标。
