Wang Yan-Ling, Yang Qi, Hu Cheng-Yan, Chu Yan-Yan, Sun Zheng, Zhao Huan, Liu Zhi
Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Chaoyang Hospital, Capital Medical University, Beijing, China.
J Geriatr Cardiol. 2022 Jun 28;19(6):435-444. doi: 10.11909/j.issn.1671-5411.2022.06.003.
Remote ischemic conditioning (RIC) is used to protect against myocardial injury. However, there is no adequate evidence for comprehensive RIC in elderly patients with ST-segment elevation myocardial infarction (STEMI). This study aimed to test whether comprehensive RIC, started pre-primary percutaneous coronary intervention (PPCI) and repeated daily on 1-30 days post-PPCI, can improve myocardial salvage index (SI), left ventricular ejection fraction (LVEF), Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) and 6-min walk test distance (6MWD) in elderly patients with acute STEMI during 12 months follow-up.
328 consenting elderly patients were randomized to receive standard PPCI plus comprehensive RIC (the treatment group) or standard PPCI (the control group). SI at 5-7 days after PPCI, LVEF, left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), KCCQ-CSS, 6MWD and adverse events rates were measured and assessed.
SI was significantly higher in the treatment group [interquartile range (IQR): 0.38-0.66, = 0.037]. There were no significant differences in major adverse events at 12 months. Although the differences of LVEDVI, LVESVI and LVEF between the treatment group and the control group did not reach statistical significance at 6 months and 12 months, LVEF tended to be higher, LVEDVI tended to be lower in the treatment group. The KCCQ-CSS was significantly higher in the treatment group at 1 month (IQR: 46.5-87, = 0.001) and 12 months (IQR: 55-93, = 0.008). There was significant difference in 6MWD between the treatment group and the control group (IQR: 258-360 IQR: 250-345, = 0.002) at 1 month and (IQR: 360-445 IQR: 345-432, = 0.035) at 12 months. A modest correlation was found between SI and LVEF ( = 0.452, < 0.01), KCCQ-CSS ( = 0.440, < 0.01) and 6MWD ( = 0.384, < 0.01) respectively at 12 months.
The comprehensive RIC can improve SI, KCCQ-CSS and 6MWD. It may be an adjunctive therapy to PPCI in elderly patients with STEMI.
远程缺血预处理（RIC）用于预防心肌损伤。然而，对于老年ST段抬高型心肌梗死（STEMI）患者进行全面RIC治疗，目前尚无充分证据。本研究旨在测试在初次经皮冠状动脉介入治疗（PPCI）前开始并在PPCI后1 - 30天每日重复进行的全面RIC，能否在12个月随访期间改善老年急性STEMI患者的心肌挽救指数（SI）、左心室射血分数（LVEF）、堪萨斯城心肌病问卷临床总结评分（KCCQ - CSS）和6分钟步行试验距离（6MWD）。
328例同意参与的老年患者被随机分为接受标准PPCI加全面RIC治疗组（治疗组）或标准PPCI对照组。测量并评估PPCI后5 - 7天的SI、LVEF、左心室舒张末期容积指数（LVEDVI）、左心室收缩末期容积指数（LVESVI）、KCCQ - CSS、6MWD及不良事件发生率。
治疗组的SI显著更高[四分位数间距（IQR）：0.38 - 0.66，P = 0.037]。12个月时主要不良事件无显著差异。尽管治疗组与对照组在6个月和12个月时LVEDVI、LVESVI和LVEF的差异未达到统计学意义，但治疗组的LVEF有升高趋势，LVEDVI有降低趋势。治疗组在1个月时（IQR：46.5 - 87，P = 0.001）和12个月时（IQR：55 - 93，P = 0.008）的KCCQ - CSS显著更高。治疗组与对照组在1个月时6MWD有显著差异（IQR：258 - 360对IQR：250 - 345，P = 0.002），在12个月时也有显著差异（IQR：360 - 445对IQR：345 - 432，P = 0.035）。在12个月时分别发现SI与LVEF（r = 0.452，P < 0.01）、KCCQ - CSS（r = 0.440，P < 0.01）和6MWD（r = 0.384，P < 0.01）之间存在适度相关性。
全面RIC可改善SI、KCCQ - CSS和6MWD。它可能是老年STEMI患者PPCI的辅助治疗方法。
