The beneficial effects of postconditioning on no-reflow phenomenon after percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction
Tóm tắt
No-reflow phenomenon is a serious complication of percutaneous coronary intervention (PCI) which is closely related to the incidence of major adverse cardiovascular events. It has been demonstrated that Postconditioning (PostC) during primary PCI confers protection against ischemia–reperfusion injury and thus might reduce infarct size. However, whether PostC may exert its beneficial effects on acute myocardial infarction (AMI) patients by reducing no-reflow phenomenon is still unknown. Sixty two patients diagnosed with ST-elevation AMI were randomly assigned to study group (n = 32) or control group (n = 30). Blood samples were obtained and assayed for creatine kinase MB (CK-MB) and high-sensitive C-reactive protein (hs-CRP). Determinants of reflow, including final thrombolysis in myocardial infarction (TIMI) grade-3 flow, ST-segment resolution (STR), myocardial blush grades-3 (MBG-3) and corrected thrombolysis in myocardial infarction frame count (cTFC), were comparative between the two groups. Compared with control group, more patients in study group were identified as the final TIMI grade-3 flow (81.3 vs. 56.7 %, P = 0.036), MBG-3 (23 vs. 14 %, P = 0.043) and STR ≥50 % (93.8 vs. 73.3 %, P = 0.029), while patients in study group had less cTFC (28.5 ± 9.1 vs. 37.4 ± 12.4, P = 0.002) After PCI, study group was associated with lower levels of CK-MB (2,397.6 ± 470.2 vs. 2,159.9 ± 485.5, P = 0.028), Troponin-I (197.5 ± 32.5 vs. 154 ± 43.1, P = 0.041) and hs-CRP (5.5 ± 4.5 vs. 9.5 ± 5.2 mg/L, P = 0.019) in comparison with control group. Left ventricle ejection fraction was better in the study group than in the control group (55.1 ± 9.8 vs. 42.9 ± 10.7, P = 0.042). PostC could improve myocardial reperfusion in patients with ST-elevation AMI undergoing PCI by reducing no-reflow. However, due to the limited sample size, the results of our study should not be considered conclusive.
Tài liệu tham khảo
Atary JZ, de Visser M, van den Dijk R, Bosch J, Liem SS et al (2010) Standardised pre-hospital care of acute myocardial infarction patients: MISSION! guidelines applied in practice. Neth Heart J 18:408–415
Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet 361:13–20
Dong-bao L, Qi H, Zhi L, Shan W, Wei-ying J (2010) Predictors and long-term prognosis of angiographic slow/no-reflow phenomenon during emergency percutaneous coronary intervention for ST-elevated acute myocardial infarction. Clin Cardiol 33:E7–E12
Reffelmann T, Kloner RA (2002) The no-reflow phenomenon: basic science and clinical correlates. Heart 87:162–168
Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J et al (2000) Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 36:1202–1209
Resnic FS, Wainstein M, Lee MK, Behrendt D, Wainstein RV et al (2003) No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J 145:42–46
Kotani J, Nanto S, Mintz GS, Kitakaze M, Ohara T et al (2002) Plaque gruel of atheromatous coronary lesion may contribute to the no-reflow phenomenon in patients with acute coronary syndrome. Circulation 106:1672–1677
Kaufmann PA, Camici PG (2005) Myocardial blood flow by PET: technical aspects and clinical applications. J Nucl Med 46:75–88
Penna C, Mancardi D, Raimondo S, Geuna S, Pagliaro P (2008) The paradigm of postconditioning to protect the heart. J Cell Mol Med 12:435–458
Yetgin T, Manintveld OC, Duncker DJ, van der Giessen WJ (2010) Postconditioning against ischaemia-reperfusion injury: ready for wide application in patients? Neth Heart J. 18:389–392
Yang XC, Liu Y, Wang LF, Cui L, Wang T et al (2007) Reduction in myocardial infarct size by postconditioning in patients after percutaneous coronary intervention. J Invasive Cardiol 19:424–430
The TIMI Study Group (1985) The thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med 312:932–936
Daneault B, Do DH, Maltais A, Bérubé S, Harvey R et al (2011) Reduction of delays in primary percutaneous coronary intervention. Can J Cardiol 27:562–566
McGovern PG, Pankow JS, Shahar E, Doliszny KM, Folsom AR et al (1996) Recent trials in acute coronary disease: mortality, morbidity, medical care and risk factors: the Minnesota Heart Survey investigators. N Eng J Med 334:884–890
Braunwald E (1989) Myocardial reperfusion, limitation of infarct size, reduction of left ventricular dysfunction and improved survival. Should the paradigm be expanded? Circulation 79:441–444
Braunwald E, Kloner RA (1985) Myocardial reperfusion: a double edged sword? J Clin Invest 76:1713–1719
Kin H, Zhao ZQ, Sun HY, Wang NP, Corvera JS et al (2004) Postconditioning attenuates myocardial ischemia–reperfusion injury by inhibiting events in the early minutes of reperfusion. Cardiovasc Res 62:74–85
Yang XM, Proctor JB, Cui L, Krieg T, Downey JM et al (2004) Multiple, brief coronary occlusions during early reperfusion protect rabbit hearts by targeting cell signaling pathways. J Am Coll Cardiol 44:1103–1110
Staat P, Rioufol G, Piot C, Cottin Y, Cung TT et al (2005) Postconditioning the human heart. Circulation 112:2143–2148
Lønborg J, Kelbaek H, Vejlstrup N, Jørgensen E, Helqvist S et al (2010) Cardioprotective effects of local ischemic postconditioning in patients treated with primary percutaneous coronary intervention, evaluated by magnetic resonance. Circ Cardiovasc Interv 3:34–41
Xue F, Yang X, Zhang B, Zhao C, Song J et al (2010) Postconditioning the human heart in percutaneous coronary intervention. Clin Cardiol 33:439–444
Laskey WK (2005) Brief repetitive balloon occlusions enhance reperfusion during percutaneous coronary intervention for acute myocardial infarction: a pilot study. Catheter Cardiovasc Interv 65:361–367
Ma X, Zhang X, Li C, Luo M (2006) Effect of postconditioning on coronary blood flow velocity and endothelial function and LV recovery after myocardial infarction. J Interv Cardiol 19:367–375
Thibault H, Piot C, Staat P, Bontemps L, Sportouch C et al (2008) Long-term benefit of postconditioning. Circulation 117:1037–1044
Thuny F, Lairez O, Roubille F, Mewton N, Rioufol G et al (2012) Post-conditioning reduces infarct size and edema in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol 59:2175–2181
Sörensson P, Saleh N, Bouvier F, Böhm F, Settergren M et al (2010) Effect of postconditioning on infarct size in patients with ST elevation myocardial infarction. Heart 96:1710–1715
Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA et al (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 97:765–772
Tomaszuk-Kazberuk A, Sobkowicz B, Kaminski K, Gugala K, Mezynski G et al (2008) Myocardial perfusion assessed by contrast echocardiography correlates with angiographic perfusion parameters in patients with a first acute myocardial infarction successfully treated with angioplasty. Can J Cardiol 24:633–639
Almansori M, Armstrong P, Fu Y, Kaul P (2010) Electrocardiographic identification of the culprit coronary artery in inferior wall ST elevation myocardial infarction. Can J Cardiol 26:293–296
Santoro GM, Valenti R, Buonamici P, Bolognese L, Cerisano G et al (1998) Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty. Am J Cardiol 82:932–937
Tomaszuk-Kazberuk A, Kozuch M, Bachorzewska-Gajewska H, Malyszko J, Dobrzycki S et al (2011) Does lack of ST-segment resolution still have prognostic value 6 years after an acute myocardial infarction treated with coronary intervention? Can J Cardiol 27:573–580
Chia S, Senatore F, Raffel OC, Lee H, Wackers FJ et al (2008) Utility of cardiac biomarkers in predicting infarct size, left ventricular function, and clinical outcome after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 1:415–423
Couvreur N, Lucats L, Tissier R, Bize A, Berdeaux A et al (2008) Differential effects of postconditioning on myocardial stunning and infarction:a study in conscious dogs and anesthetized rabbits. Am J Physiol Heart Circ Physiol 291:H1345–H1350
Zeng M, Yan H, Chen Y, Zhao HJ, Lv Y et al (2012) Suppression of NF-κB reduces myocardial no-reflow. PLoS ONE 7:e47306
Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH (1998) Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 98:731–733
Chew DP, Bhatt DL, Robbins MA, Penn MS, Schneider JP et al (2001) Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in percutaneous coronary intervention. Circulation 104:992–997