The effect and safety of ischemic postconditioning in patients with acute myocardial infarction having underwent percutaneous coronary intervention
10.3760/cma.j.issn.1673-4904.2015.10.003
- VernacularTitle:缺血后适应对急性心肌梗死介入术后心肌灌注的影响及安全性
- Author:
Shaonan LI
;
Chong ZENG
;
Fujun YU
;
Zhen LIU
;
Xiaoming LEI
- Publication Type:Journal Article
- Keywords:
Myocardial infarction;
Postconditioning;
Myocardial perfusion
- From:
Chinese Journal of Postgraduates of Medicine
2015;38(10):709-713
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effect and mechanism of ischemic postconditioning (IPC) on myocardial perfusion levels of acute ST-segment elevation myocardial infarction (STEMI) patients having underwent primary percutaneous coronary intervention (PCI), and the safety of IPC. Methods One hundred and sixty patients with STEMI were enrolled, and they accepted the primary PCI therapy within the onset of 12 h. The patients were divided into 2 groups according the treatment method:control group (routine PCI group, 82 cases) and IPC group (78 cases). The ST-segment resolution, TIMI myocardial perfusion grade (TMPG), before and after PCI levels of nitrogen monoxidum (NO), endothelin (ET)-1, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI)-1, rate of intraoperative complication were observed. The patients were followed up for 6 months, the rate of major adverse cardiac event (MACE) was recorded. Results The rates of ST-segment resolution and TMPG well in IPC group were significantly higher than those in control group:84.62%(66/78) vs. 67.07%(55/82) and 80.77%(63/78) vs. 64.63%(53/82), and the rate of ischemia-reperfusion injury in IPC group was significantly lower than that in control group: 7.69%(6/78) vs. 24.39%(20/82), and there were statistical differences ( P<0.05 or<0.01). The endothelial function and fibrinolysis activity indexes (NO, ET-1, t-PA and PAI-1 levels ) 7 d after PCI in IPC group were significantly better than those in control group: (52.37 ± 3.84) μmol/L vs. (50.95 ±3.85) μmol/L, (75.47 ±3.47) ng/L vs. (76.61 ±3.72) ng/L, (12.96 ±1.25) μg/L vs. (12.52 ±1.23) μg/L, (21.78 ±4.01)μg/L vs. (24.95±7.56)μg/L, and there were statistical differences (P<0.05 or<0.01). There was no statistical difference in the rate of intraoperative complication between 2 groups ( P>0.05). The rate of MACE in IPC group was significantly lower than that in control group:3.85% (3/78) vs. 14.63% (12/82), and there was statistical difference (P<0.05). Conclusions Applying IPC in patients with STEMI having underwent primary PCI is safe and can improve myocardial perfusion levels. The improvement of vessel endothelial function and fibrinolysis activity attained from IPC may be the major mechanism.
