高强度他汀预负荷对接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者心肌灌注分级血流的影响。

Effect of high-intensity statin preloading on TIMI flow in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

作者信息

Elserafy Ahmed Shawky, Farag Nabil Mahmoud, El Desoky Ahmed Ibrahim, Eletriby Khaled Adel

机构信息

Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt.

出版信息

Egypt Heart J. 2020 Jul 10;72(1):40. doi: 10.1186/s43044-020-00074-0.

DOI:10.1186/s43044-020-00074-0

PMID:32651772

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7352020/

Abstract

BACKGROUND

Acute ST-elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality worldwide. Primary percutaneous coronary intervention (PCI) has improved the outcomes from STEMI and improved myocardial perfusion. However, there is still room for medical therapy to help perfuse the myocardium. The aim of this study was to assess the impact of high-intensity statins used prior to primary PCI in patients presenting with acute STEMI on myocardial perfusion. The study included 170 patients who presented with acute STEMI to Ain Shams University Hospitals and underwent primary percutaneous coronary intervention (PCI). They were divided into two groups where the first group received high-intensity statins (80 mg of atorvastatin or 20 mg of rosuvastatin) besides guideline-recommended therapy before primary PCI and the second group served as a control group and received guideline-recommended therapy, and high-intensity statins were given as usual after going back to the coronary care unit after primary PCI. Post-interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded, and ST-segment resolution was measured.

RESULTS

The LAD was the culprit vessel for the majority of patients in both groups. In the control group, there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II, and 68 with TIMI III flow and MBG III. Meanwhile, in the cases group, there was 1 patient with TIMI I flow and MBG I, 3 with TIMI II flow and MBG II, and 81 with TIMI III flow and MBG III. This difference was statistically significant with a P value of 0.010. There were 34 patients in the cases group who showed complete ST-segment resolution (40%) vs. 19 patients (22.4%) in the control group which was statistically significant with a P value of 0.013. In addition, ejection fraction had values of mean ± SD of 45.91 ± 5.49 in the cases group vs. 43.01 ± 8.80 in the control group which was statistically significant with a P value of 0.011.

CONCLUSION

High-intensity statin loading before primary PCI resulted in improved post-procedural TIMI flow, MBG, complete ST-segment resolution, and ejection fraction.

摘要

背景

急性ST段抬高型心肌梗死（STEMI）是全球发病和死亡的主要原因。直接经皮冠状动脉介入治疗（PCI）改善了STEMI的治疗效果并提高了心肌灌注。然而，药物治疗在帮助心肌灌注方面仍有提升空间。本研究的目的是评估急性STEMI患者在直接PCI前使用高强度他汀类药物对心肌灌注的影响。该研究纳入了170例到艾因夏姆斯大学医院就诊并接受直接经皮冠状动脉介入治疗（PCI）的急性STEMI患者。他们被分为两组，第一组在直接PCI前除接受指南推荐的治疗外，还接受高强度他汀类药物（80毫克阿托伐他汀或20毫克瑞舒伐他汀）治疗，第二组作为对照组，接受指南推荐的治疗，且在直接PCI后返回冠心病监护病房后按常规给予高强度他汀类药物治疗。记录介入术后心肌梗死溶栓（TIMI）血流分级和心肌 blush分级（MBG），并测量ST段回落情况。

结果

两组中大多数患者的罪犯血管均为左前降支（LAD）。对照组中，有4例患者TIMI血流I级且MBG I级，13例TIMI血流II级且MBG II级，68例TIMI血流III级且MBG III级。同时，病例组中，有1例患者TIMI血流I级且MBG I级，3例TIMI血流II级且MBG II级，81例TIMI血流III级且MBG III级。这种差异具有统计学意义，P值为0.010。病例组中有34例患者ST段完全回落（40%），而对照组中有19例（22.4%），差异具有统计学意义，P值为0.013。此外，病例组的射血分数平均值±标准差为45.91±5.49，对照组为43.01±8.80，差异具有统计学意义，P值为0.011。