Sinha Santosh Kumar, Jha Mukesh Jitendra, Aggarwal Puneet, Pandey Umeshwar, Sharma Awadesh Kumar, Razi Mahmodullah, Khanra Dibbendhu, Thakur Ramesh, Krishna Vinay
Department of Cardiology, LPS Institute of Cardiology, Kanpur, India.
Department of Cardiology, Sri Aurobindo Institute of Cardiology, Indore, India.
Arch Med Sci Atheroscler Dis. 2020 Dec 29;5:e271-e278. doi: 10.5114/amsad.2020.102424. eCollection 2020.
No-reflow is an infrequent but dreaded complication of percutaneous coronary intervention (PCI), where the culprit is obstruction of the downstream microvascular bed. The aim of this study was to evaluate the efficacy and safety of forceful injection of blood (autologous blood transfusion - ABT) in reversing no-reflow during PCI because data regarding its effectiveness is not available.
100-120 ml of blood was withdrawn through guiding catheter over 3 to 5 min using a 10 ml syringe and re-infused by forceful injection over 3 min through it, and its efficacy was assessed at 10 min using TIMI flow grade and quantitative corrected TIMI frame count.
In total 93 patients received ABT following no-reflow. Their clinical presentation was ST-elevation myocardial infarction (STEMI) ( = 61; 65.6%), non-ST-elevation myocardial infarction (NSTEMI) ( = 23; 24.7%), and unstable angina ( = 9; 9.6%). It was observed among patients undergoing primary PCI ( = 18; 19.3%), pharmaco-invasive PCI ( = 27; 29%), rescue PCI ( = 11; 11.8%), and PCI for cardiogenic shock ( = 5; 5.3%). A mean volume of 108 ±4 ml blood was transfused. Commonest culprit vessel was left anterior descending artery ( = 51; 54.8%) followed by right coronary ( = 29; 31.2%), left circumflex ( = 19; 10.8%), and saphenous vein grafts ( = 3; 3.2%). Following ABT, TIMI 3 flow was successfully restored in 77 (82.7%) patients. TIMI flow grade improved from 1.02 to 2.52 and cTIMI frame count decreased from 60.6 ±12 to 16.1 ±6 ( < 0.001). ABT was well tolerated except transient hypotension ( = 17; 18.3%). Overall mortality was reported in 10 (10.7%) patients at 1 year.
In this largest and only study to date, ABT is a safe and highly effective approach to reverse no-reflow by raising driving pressure across the capillary bed.
无复流是经皮冠状动脉介入治疗（PCI）中一种少见但可怕的并发症，其罪魁祸首是下游微血管床的阻塞。本研究的目的是评估强力注射血液（自体输血 - ABT）在PCI期间逆转无复流的有效性和安全性，因为尚无关于其有效性的数据。
使用10毫升注射器在3至5分钟内通过引导导管抽取100 - 120毫升血液，并在3分钟内通过引导导管强力注射回输，在10分钟时使用TIMI血流分级和定量校正TIMI帧数来评估其效果。
共有93例患者在出现无复流后接受了ABT。他们的临床表现为ST段抬高型心肌梗死（STEMI）（n = 61；65.6%）、非ST段抬高型心肌梗死（NSTEMI）（n = 23；24.7%）和不稳定型心绞痛（n = 9；9.6%）。在接受直接PCI（n = 18；19.3%）、药物介入性PCI（n = 27；29%）、补救性PCI（n = 11；11.8%）和心源性休克PCI（n = 5；5.3%）的患者中观察到该情况。平均回输血量为108±4毫升。最常见的罪犯血管是左前降支（n = 51；54.8%），其次是右冠状动脉（n = 29；31.2%）、左旋支（n = 19；10.8%）和大隐静脉桥血管（n = 3；3.2%）。ABT后，77例（82.7%）患者成功恢复TIMI 3级血流。TIMI血流分级从1.02提高到2.52，校正TIMI帧数从60.6±12降至16.1±6（P < 0.001）。除了短暂性低血压（n = 17；18.3%）外，ABT耐受性良好。1年时报告的总死亡率为10例（10.7%）。
在这项迄今为止规模最大且唯一的研究中，ABT是一种通过提高跨毛细血管床的驱动压力来逆转无复流的安全且高效的方法。
