急性ST段抬高型心肌梗死总缺血时间对再灌注冠脉血流和近期预后的影响
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摘要
目的评估急性ST段抬高型心肌梗死总缺血时间对再灌注冠脉血流和近期预后的影响。方法回顾性分析急性ST段抬高型心肌梗死行直接PCI患者187例,根据PCI术前负荷抗血小板药物不同分为替格瑞洛组(T组)和氯吡格雷组(C组),各组再根据患者总缺血时间中位数分为T1组(<180 min)和T2组(≥180 min)、C1组(<180 min)和C2组(≥180min)。将T1和C1组合并为D1组(<180 min,90例),将T2、C2组合并为D2组(≥180 min,97例),比较各组TIMI血流变化情况、术后校正的TIMI血流计数帧数(CTFC)、急诊PCI术后2小时内的心电图ST段回落指数(STR)等心肌血流灌注指标以及对心功能的影响。结果与T2、C2、D2组比较,T1、C1、D1组在直接PCI术后STR50%较高,CTFC较低,差异有统计学意义(P <0. 05);与C1和C2组比较,T1、T2组在直接PCI术后STR50%较高,CTFC较低(P <0. 05)。住院期间及出院后3月随访时D1组LVEF均高于D2组,LVEDD低于D2组; D1组MACE发生率低于D2组,差异均有统计学意义(P <0. 05)。结论急性ST段抬高型心肌梗死患者总缺血时间延长会增加直接PCI术中无复流的发生率,并影响心功能和短期预后,早期负荷新型抗血小板药物替格瑞洛能显著减少PCI术中无复流的发生。
Objective To assess the effect of ischemic-time on coronary blood flow and short-term prognosis in patients with acute ST-segment elevation myocardial infarction( STEMI).Methods A total of 187 patients with acute STEMI were retrospectively analyzed.The patients were divided into ticagrelor group( group T) and clopidogrel group( group C) according to different preloading antiplatelet drugs before percutaneous coronary intervention( PCI).The two groups were further divided into T1( <180 min) and T2( ≥180 min) or C1( <180 min) and C2( ≥180 min) subgroups according to total ischemic time.Furthermore,T1 and C1 subgroups were combined as D1 subgroup( n = 90),and T2 and C2 subgroups were combined as D2 subgroup( n = 97).TIMI blood flow,corrected TIMI flow count frames( CTFC),and ST-segment elevation resolution( STR) within 2 hours after emergency PCI and other myocardial perfusion indicators as well as their effects on heart function were compared.Results Compared to the T2,C2 and D2 subgroups,the total drop rate of STR50% after direct PCI surgery in the T1,C1 or D1 subgroup was higher while CTFC was lower( P < 0. 05).Compared to the C1 and C2 subgroups,the complete fall rate of STR50% was higher while CTFC was lower in the T1 and T2 subgroups( P< 0. 05).The LVEF value of cardiac ultrasound was higher and the incidence of total MACE events was lower in the D1 subgroup than those of the D2 subgroup during hospitalization( P < 0. 05).Conclusion For patients with acute STEMI,prolonging ischemic time increases the incidence of no-reflow in primary PCI,and affects cardiac function and prognosis.Early administration of ticagrelor can significantly reduce the incidence of no-reflow in primary PCI.
Objective To assess the effect of ischemic-time on coronary blood flow and short-term prognosis in patients with acute ST-segment elevation myocardial infarction( STEMI).Methods A total of 187 patients with acute STEMI were retrospectively analyzed.The patients were divided into ticagrelor group( group T) and clopidogrel group( group C) according to different preloading antiplatelet drugs before percutaneous coronary intervention( PCI).The two groups were further divided into T1( <180 min) and T2( ≥180 min) or C1( <180 min) and C2( ≥180 min) subgroups according to total ischemic time.Furthermore,T1 and C1 subgroups were combined as D1 subgroup( n = 90),and T2 and C2 subgroups were combined as D2 subgroup( n = 97).TIMI blood flow,corrected TIMI flow count frames( CTFC),and ST-segment elevation resolution( STR) within 2 hours after emergency PCI and other myocardial perfusion indicators as well as their effects on heart function were compared.Results Compared to the T2,C2 and D2 subgroups,the total drop rate of STR50% after direct PCI surgery in the T1,C1 or D1 subgroup was higher while CTFC was lower( P < 0. 05).Compared to the C1 and C2 subgroups,the complete fall rate of STR50% was higher while CTFC was lower in the T1 and T2 subgroups( P< 0. 05).The LVEF value of cardiac ultrasound was higher and the incidence of total MACE events was lower in the D1 subgroup than those of the D2 subgroup during hospitalization( P < 0. 05).Conclusion For patients with acute STEMI,prolonging ischemic time increases the incidence of no-reflow in primary PCI,and affects cardiac function and prognosis.Early administration of ticagrelor can significantly reduce the incidence of no-reflow in primary PCI.
引文
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[6]Dogan NB,Ozpelit E,Akdeniz S,et al.Simple clinical risk score for no-reflow prediction in patients undergoing primary Percutaneous Coronary Intervention with acute STEMI[J].Pak J Med Sci,2015,31(3):576-581.
[7]Acet H,Ertas F,Akil MA,et al.The utility of the TIMI risk index on admission for predicting angiographic no-reflow after primary percutaneous coronary intervention in patients with STEMI[J]. Turk J Med Sci,2016,46(3):604-613.
[8]Foo CY,Reidpath DD,Chaiyakunapruk N. The effect of door-toballoon delay in primary percutaneous coronary intervention on clinical outcomes of STEMI:a systematic review and meta-analysis protocol[J].Syst Rev,2016,5(1):130.
[9]Mewton N,Thibault H,Roubille F,et al. Postconditioning attenuates no-reflow in STEMI patients[J]. Basic Res Cardiol,2013,108(6):383.
[10]Van Camp Guy,De Backer T,Beauloye C,et al. Summary of 2017ESC guidelines on valvular heart disease,peripheral artery disease,STEMI and on dual antiplatelet therapy[J]. Acta Cardiol,2018,73(5):419-425.
[11]常慧艳,乔青,张荣林.ST段抬高型心肌梗死患者总缺血时间的影响因素分析[J].临床心血管病杂志,2015,24(5):511-514.
[12]Bates ER,Jacobs AK.Time to treatment in patients with STEMI[J].N Engl J Med,2013,369(10):889-892.
[13]Bayramoglu A,Tasolar H,Kaya A,et al.Prediction of no-reflow and major adverse cardiovascular events with a new scoring system in STEMI patients[J].J Interv Cardiol,2018,31(2):144-149.
[14]Kohli P,Wallentin L,Reyes E,et al.Reduction in first and recurrent cardiovascular events with ticagrelor compared with clopidogrel in the PLATO Study[J].Circulation,2013,127(6):673-680.
[15]Krisai P,Haschke M,Buser PT,et al.Ticagrelor induced systemic inflammatory response syndrome[J].BMC Cardiovasc Disord,2017,17(1):14.
[2]Yamada T,Takahashi A,Mizuguchi Y,et al.Impact of shorter doorto-balloon time on prognosis of patients with STEMI-single-center analysis with a large proportion of the patients treated within 30 min[J].Cardiovasc Interv Ther,2018,18:Epub ahead of Print.
[3] Valente S,Lazzeri C,Chiostri M,et al. The impact of blood transfusion on short and long term prognosis in STEMI patients treated with primary percutaneous coronary intervention:a single center-experience[J].Int J Cardiol,2012,157(2):281-283.
[4]Foo CY,Bonsu KO,Nallamothu BK,et al.Coronary intervention doorto-balloon time and outcomes in ST-elevation myocardial infarction:a meta-analysis[J].Heart,2018,104(16):1362-1369.
[5]Khalid U,Jneid H,Denktas AE.The relationship between total ischemic time and mortality in patients with STEMI:every second counts[J].Cardiovasc Diagn Ther,2017,7(Suppl 2):S119-S124.
[6]Dogan NB,Ozpelit E,Akdeniz S,et al.Simple clinical risk score for no-reflow prediction in patients undergoing primary Percutaneous Coronary Intervention with acute STEMI[J].Pak J Med Sci,2015,31(3):576-581.
[7]Acet H,Ertas F,Akil MA,et al.The utility of the TIMI risk index on admission for predicting angiographic no-reflow after primary percutaneous coronary intervention in patients with STEMI[J]. Turk J Med Sci,2016,46(3):604-613.
[8]Foo CY,Reidpath DD,Chaiyakunapruk N. The effect of door-toballoon delay in primary percutaneous coronary intervention on clinical outcomes of STEMI:a systematic review and meta-analysis protocol[J].Syst Rev,2016,5(1):130.
[9]Mewton N,Thibault H,Roubille F,et al. Postconditioning attenuates no-reflow in STEMI patients[J]. Basic Res Cardiol,2013,108(6):383.
[10]Van Camp Guy,De Backer T,Beauloye C,et al. Summary of 2017ESC guidelines on valvular heart disease,peripheral artery disease,STEMI and on dual antiplatelet therapy[J]. Acta Cardiol,2018,73(5):419-425.
[11]常慧艳,乔青,张荣林.ST段抬高型心肌梗死患者总缺血时间的影响因素分析[J].临床心血管病杂志,2015,24(5):511-514.
[12]Bates ER,Jacobs AK.Time to treatment in patients with STEMI[J].N Engl J Med,2013,369(10):889-892.
[13]Bayramoglu A,Tasolar H,Kaya A,et al.Prediction of no-reflow and major adverse cardiovascular events with a new scoring system in STEMI patients[J].J Interv Cardiol,2018,31(2):144-149.
[14]Kohli P,Wallentin L,Reyes E,et al.Reduction in first and recurrent cardiovascular events with ticagrelor compared with clopidogrel in the PLATO Study[J].Circulation,2013,127(6):673-680.
[15]Krisai P,Haschke M,Buser PT,et al.Ticagrelor induced systemic inflammatory response syndrome[J].BMC Cardiovasc Disord,2017,17(1):14.