Department of Coronary Care Unit, Tianjin Chest Hospital, Tianjin 300222, China.
Chin Med J (Engl). 2020 Apr 5;133(7):766-772. doi: 10.1097/CM9.0000000000000709.
Various experimental and clinical studies have reported on coronary microcirculatory dysfunction ("no-reflow" phenomenon). Nevertheless, pathogenesis and effective treatment are yet to be fully elucidated. This study aimed to measure the intracoronary pressure gradient in the no-reflow artery during emergent percutaneous coronary intervention and explore the potential mechanism of no-reflow.
From September 1st, 2018 to June 30th, 2019, intracoronary pressure in acute myocardial infarction patient was continuously measured by aspiration catheter from distal to proximal segment in the Department of Coronary Care Unit, Tianjin Chest Hospital, respectively in no-reflow arteries (no-reflow group) and arteries with thrombolysis in myocardial infarction-3 flow (control group). At least 12 cardiac cycles were consecutively recorded when the catheter was pulled back. The forward systolic pressure gradient was calculated as proximal systolic pressure minus distal systolic pressure. Comparison between groups was made using the Student t test, Mann-Whitney U-test or Chi-square test, as appropriate.
Intracoronary pressure in 33 no-reflow group and 26 in control group were measured. The intracoronary forward systolic pressure gradient was -1.3 (-4.8, 0.7) and 3.8 (0.8, 8.8) mmHg in no-reflow group and control group (Z = -3.989, P < 0.001), respectively, while the forward diastolic pressure gradient was -1.0 (-3.2, 0) and 4.6 (0, 16.5) mmHg in respective groups (Z = -3.851, P < 0.001). Moreover, the intracoronary forward pressure gradient showed significant difference between that before and after nicorandil medication (Z = -3.668, P < 0.001 in systolic pressure gradient and Z = -3.530, P < 0.001 in diastolic pressure gradient).
No reflow during emergent coronary revascularization is significantly associated with local hemodynamic abnormalities in the coronary arteries. Intracoronary nicorandil administration at the distal segment of a coronary artery with an aspiration catheter could improve the microcirculatory dysfunction and resume normal coronary pressure gradient.
www.ClinicalTrials.gov (No. NCT03600259).
多项实验和临床研究报告了冠状动脉微循环功能障碍（“无复流”现象）。然而，其发病机制和有效治疗仍未完全阐明。本研究旨在测量急诊经皮冠状动脉介入治疗时无复流动脉的冠状动脉内压力梯度，并探讨无复流的潜在机制。
2018 年 9 月 1 日至 2019 年 6 月 30 日，在天津市胸科医院冠心病监护病房，分别通过抽吸导管连续测量急性心肌梗死患者无复流动脉（无复流组）和经溶栓治疗的心肌梗死血流 3 级（对照组）的近段至远段的冠状动脉内压力。当导管回拉时，连续记录至少 12 个心动周期。近端收缩压减去远端收缩压计算前向收缩压梯度。组间比较采用 t 检验、Mann-Whitney U 检验或卡方检验。
共测量了 33 例无复流组和 26 例对照组的冠状动脉内压力。无复流组和对照组的冠状动脉前向收缩压梯度分别为-1.3（-4.8，0.7）和 3.8（0.8，8.8）mmHg（Z= -3.989，P<0.001），前向舒张压梯度分别为-1.0（-3.2，0）和 4.6（0，16.5）mmHg（Z= -3.851，P<0.001）。此外，尼可地尔治疗前后冠状动脉内前向压力梯度差异有统计学意义（收缩压梯度 Z= -3.668，P<0.001；舒张压梯度 Z= -3.530，P<0.001）。
紧急血运重建时无复流与冠状动脉局部血流动力学异常明显相关。经抽吸导管在冠状动脉远段给药尼可地尔可改善微循环功能障碍，恢复正常冠状动脉压力梯度。
