"Dedinje" Cardiovascular Institute, Belgrade, Serbia,
"Dedinje" Cardiovascular Institute, Belgrade, Serbia.
Blood Purif. 2020;49(6):753-757. doi: 10.1159/000506176. Epub 2020 Feb 28.
In patients with ST-elevation myocardial infarction (STEMI), C-reactive protein (CRP) levels are associated with larger infarct size, transmural extent, and poor function of left ventricle and independently predict 30-day mortality. CRP-apheresis following STEMI showed to be feasible, safe, and has significant beneficial effect both on myocardial infarction size and wall motion. To the best of our knowledge, this is only the second published clinical evaluation of the efficacy and safety of selective CRP-apheresis in the STEMI treatment using Spectra-Optia and Pentrasorb CRP-adsorber systems.
A 53-year-old female was referred with anterior STEMI. After percutaneous coronary intervention, patient received standard post-STEMI therapy according to current guidelines. Selective therapeutic plasma exchange (TPE) was performed using Spectra-Optia (Terumo BCT; USA) and Pentrasorb CRP-adsorber (Pentracor GmbH; Germany) systems. Antecubital veins were used for vascular access and acid-citrate-dextrose solution (ACD formula A; total volume = 1,026 mL) was utilized as anticoagulant. The volume of processed blood was 15,600 mL. The removed "natural" plasma (total volume = 8,329 mL) was replaced with CRP-depleted autologous plasma (total volume = 8,085 mL). This intensive TPE-treatment was well tolerated, without adverse effects, or complications. The CRP plasma levels were: initial = 4.2 mg/L 6 h after acute myocardial infarction (AMI), pre-apheresis = 16.4 mg/L, and post-apheresis = 4.59 mg/L (CRP-depletion = 72%). There were neither significant changes observed in biochemistry nor any alterations in plasma hemostatic activity investigated before and after CRP-adsorption performed.
Early performed CRP-apheresis is a promising innovative therapeutic approach for STEMI treatment that could provide a reduced size of infarction zone - with inferior occurrence of heart failure after AMI. However, precise and complete evaluation of the efficacy and safety of this treatment requires further multicenter randomized and larger clinical studies.
在 ST 段抬高型心肌梗死（STEMI）患者中，C 反应蛋白（CRP）水平与梗死面积较大、透壁程度和左心室功能不良有关，并且独立预测 30 天死亡率。STEMI 后 CRP 吸附显示是可行的、安全的，并且对心肌梗死面积和壁运动都有显著的有益效果。据我们所知，这是使用 Spectra-Optia 和 Pentrasorb CRP 吸附器系统在 STEMI 治疗中发表的仅有的第二项关于选择性 CRP 吸附的疗效和安全性的临床评估。
一名 53 岁女性因前壁 STEMI 被转介。经皮冠状动脉介入治疗后，患者根据当前指南接受了标准的 STEMI 后治疗。使用 Spectra-Optia（Terumo BCT；美国）和 Pentrasorb CRP 吸附器（Pentracor GmbH；德国）系统进行选择性治疗性血浆置换（TPE）。肘前静脉用于血管通路，使用柠檬酸-葡萄糖-右旋糖酐溶液（ACD 配方 A；总量=1026 毫升）作为抗凝剂。处理的血液量为 15600 毫升。去除的“天然”血浆（总量=8329 毫升）用 CRP 耗尽的自体血浆（总量=8085 毫升）代替。这种强化 TPE 治疗耐受性良好，无不良反应或并发症。CRP 血浆水平为：急性心肌梗死（AMI）后 6 小时初始值=4.2 毫克/升，预处理前=16.4 毫克/升，处理后=4.59 毫克/升（CRP 耗竭=72%）。在 CRP 吸附前后进行的生化检查中，均未观察到明显变化，血浆止血活性也未发生变化。
早期进行 CRP 吸附是 STEMI 治疗的一种有前途的创新治疗方法，可减少梗死区的面积-降低 AMI 后心力衰竭的发生。然而，这种治疗的疗效和安全性的精确和完整评估需要进一步的多中心随机和更大规模的临床研究。
