经皮冠状动脉介入术后冠状动脉无复流现象的研究进展
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摘要
经皮冠状动脉介入术(PCI)是目前心肌血运重建的主要手段,其可迅速开通梗死相关动脉,恢复心肌血运,保护心功能,但无复流现象严重影响PCI临床疗效及患者预后。无复流现象是PCI常见并发症之一,是指在冠状动脉无明显持续性机械性病变情况下发生向前血流明显减慢或完全无血流的现象。本文综述了PCI后冠状动脉无复流现象的研究进展,以期为临床有效防治无复流现象提供参考。
At present,percutaneous coronary intervention(PCI)is the main method of myocardial revascularization,it can quickly open the infarct-related artery,restore myocardial blood flow and protect cardiac function,but no-reflow phenomenon may badly affect the clinical effect of PCI and the patients' prognosis. No-reflow phenomenon is one of common complications of PCI,means coronary forward flow significantly slow down or completely absent without apparently continuous mechanical lesion. Therefore,this paper reviewed the progress on coronary no-reflow phenomenon after PCI,to provide a reference for the effective prevention and treatment of no-reflow phenomenon.
At present,percutaneous coronary intervention(PCI)is the main method of myocardial revascularization,it can quickly open the infarct-related artery,restore myocardial blood flow and protect cardiac function,but no-reflow phenomenon may badly affect the clinical effect of PCI and the patients' prognosis. No-reflow phenomenon is one of common complications of PCI,means coronary forward flow significantly slow down or completely absent without apparently continuous mechanical lesion. Therefore,this paper reviewed the progress on coronary no-reflow phenomenon after PCI,to provide a reference for the effective prevention and treatment of no-reflow phenomenon.
引文
[1]李然,邱春光,韩战营.冠状动脉无复流现象的病理生理学研究进展[J].河南医学研究,2013,22(1):153-156.
[2]NDREPEPA G,TIROCH K,KETA D,et al.Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction[J].Circ Cardiovasc Interv,2010,3(1):27-33.DOI:10.1161/CIRCINTERVENTIONS.109.896225.
[3]FREIXA X,HERAS M,ORTIZ J T,et al.Usefulness of endothelin-1 assessment in acute myocardial infarction[J].Rev Esp Cardiol,2011,64(2):105-110.DOI:10.1016/j.recesp.2010.07.001.
[4]EITEL I,NOWAK M,STEHL C,et al.Endothelin-1 release in acute myocardial infarction as a predictor of long-term prognosis and no-reflow assessed by contrast-enhanced magnetic resonance imaging[J].Am Heart J,2010,159(5):882-890.DOI:10.1016/j.ahj.2010.02.019.
[5]REINDL M,REINSTADLER S J,FEISTRITZER H J,et al.Relation of inflammatory markers with myocardial and microvascular injury in patients with reperfused ST-elevation myocardial infarction[J].Eur Heart J Acute Cardiovasc Care,2017,6(7):640-649.DOI:10.1177/2048872616661691.
[6]LEE M J,PARK S D,KWON S W,et al.Relation between neutrophil-to-lymphocyte ratio and index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Am J Cardiol,2016,118(9):1323-1328.DOI:10.1016/j.amjcard.2016.07.072.
[7]KIM M K,CHUNG W Y,CHO Y S,et al.Serum N-terminal proB-type natriuretic peptide levels at the time of hospital admission predict of microvascular obstructions after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction[J].J Interv Cardiol,2011,24(1):34-41.DOI:10.1111/j.1540-8183.2010.00606.x.
[8]FABREGAT-ANDRéSó,CUBILLOS A,FERRANDOBELTRáN M,et al.Mean platelet volume is associated with infarct size and microvascular obstruction estimated by cardiac magnetic resonance in ST segment elevation myocardial infarction[J].Blood Coagul Fibrinolysis,2013,24(4):424-427.DOI:10.1097/MBC.0b013e32835d9bca.
[9]MARENZI G,GIORGIO M,TRINEI M,et al.Circulating cytochrome c as potential biomarker of impaired reperfusion in STsegment elevation acute myocardial infarction[J].Am J Cardiol,2010,106(10):1443-1449.DOI:10.1016/j.amjcard.2010.07.014.
[10]OTA S,TANIMOTO T,ORII M,et al.Association between hyperglycemia at admission and microvascular obstruction in patients with ST-segment elevation myocardial infarction[J].J Cardiol,2015,65(4):272-277.DOI:10.1016/j.jjcc.2014.10.013.
[11]MARFELLA R,ESPOSITO K,GIUNTA R,et al.Circulating adhesion molecules in humans:role of hyperglycemia and hyperinsulinemia[J].Circulation,2000,101(19):2247-2251.
[12]MONTONE R A,NICCOLI G,MINELLI S,et al.Clinical outcome and correlates of coronary microvascular obstruction in latecomers after acute myocardial infarction[J].Int J Cardiol,2017,236:30-35.DOI:10.1016/j.ijcard.2017.02.023.
[13]CHOI S,JANG W J,SONG Y B,et al.D-dimer levels predict myocardial injury in ST-segment elevation myocardial infarction:a cardiac magnetic resonance imaging study[J].PLo S One,2016,11(8):e0160955.DOI:10.1371/journal.pone.0160955.
[14]LAYLAND J,NERLEKAR N,PALMER S,et al.Invasive assessment of the coronary microcirculation in the catheter laboratory[J].Int J Cardiol,2015,199:141-149.DOI:10.1016/j.ijcard.2015.05.190.
[15]DING S,LI Z,GE H,et al.Impact of early ST-segment changes on cardiac magnetic resonance-verified intramyocardial haemorrhage and microvascular obstruction in ST-elevation myocardial infarction patients[J].Medicine(Baltimore),2015,94(35):e1438.DOI:10.1097/MD.0000000000001438.
[16]ROMMEL K P,BADARNIH H,DESCH S,et al.QRS complex distortion(Grade 3 ischaemia)as a predictor of myocardial damage assessed by cardiac magnetic resonance imaging and clinical prognosis in patients with ST-elevation myocardial infarction[J].Eur Heart J Cardiovasc Imaging,2016,17(2):194-202.DOI:10.1093/ehjci/jev135.
[17]CAMICI P G,D'AMATI G,RIMOLDI O.Coronary microvascular dysfunction:mechanisms and functional assessment[J].Nat Rev Cardiol,2015,12(1):48-62.DOI:10.1038/nrcardio.2014.160.
[18]LEUNG D Y,LEUNG M.Non-invasive/invasive imaging:significance and assessment of coronary microvascular dysfunction[J].Heart,2011,97(7):587-595.DOI:10.1136/hrt.2009.183327.
[19]FRIEDRICH M G,KRAMER C M,SODICKSON D K,et al.Meeting highlights of the 10th annual scientific sessions of the Society for Cardiovascular Magnetic Resonance and 6th annual meeting of the Working Group for Cardiovascular Magnetic Resonance of the European Society of Cardiology:Rome,Italy,February 2-4,2007[J].J Am Coll Cardiol,2007,50(10):983-987.
[20]GUPTA S,GUPTA M M.No reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction[J].Indian Heart J,2016,68(4):539-551.DOI:10.1016/j.ihj.2016.04.006.
[21]HAMIRANI Y S,KRAMER C M.Cardiac MRI assessment of myocardial perfusion[J].Future Cardiol,2014,10(3):349-358.DOI:10.2217/fca.14.18.
[22]黄希.冠状动脉无复流现象的机制、诊断和防治进展[J].广西医科大学学报,2012,29(1):160-163.DOI:10.3969/j.issn.1005-930X.2012.01.069.
[23]AMIER R P,TEUNISSEN P F,MARQUES K M,et al.Invasive measurement of coronary microvascular resistance in patients with acute myocardial infarction treated by primary PCI[J].Heart,2014,100(1):13-20.DOI:10.1136/heartjnl-2013-303832.
[24]KLONER R A,GANOTE C E,JENNINGS R B.The"no-reflow"phenomenon after temporary coronary occlusion in the dog[J].J Clin Invest,1974,54(6):1496-1508.
[25]SCALONE G,AURIGEMMA C,TOMAI F,et al.Effect of preinfarction angina on platelet reactivity in acute myocardial infarction[J].Int J Cardiol,2013,167(1):51-56.DOI:10.1016/j.ijcard.2011.11.085.
[26]马晓静,张兴华,罗曼,等.缺血预适应与缺血后适应现象对急性心肌梗死急症介入治疗后的影响[J].中华医学杂志,2007,87(2):114-117.DOI:10.3760/j:issn:0376-2491.2007.02.011.
[27]ILIODROMITIS E K,GEORGIADIS M,COHEN M V,et al.Protection from post-conditioning depends on the number of short ischemic insults in anesthetized pigs[J].Basic Res Cardiol,2006,101(6):502-507.DOI:10.1007/s00395-006-0606-3.
[28]JANSEN VAN VUREN P,POTGIETER A C,PAWESKA J T,et al.Preparation and evaluation of a recombinant Rift Valley fever virus N protein for the detection of Ig G and Ig M antibodies in humans and animals by indirect ELISA[J].J Virol Methods,2007,140(1/2):106-114.DOI:10.1016/j.jviromet.2006.11.005.
[29]ABDELAZIZ H K,ELKILANY W,KHALID S,et al.Efficacy and safety of intracoronary verapamil versus sodium nitroprusside for the prevention of microvascular obstruction during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction[J].Coron Artery Dis,2017,28(1):11-16.DOI:10.1097/MCA.0000000000000423.
[30]GUARINI G,HUQI A,MORRONE D,et al.Pharmacological approaches to coronary microvascular dysfunction[J].Pharmacol Ther,2014,144(3):283-302.DOI:10.1016/j.pharmthera.2014.06.008.
[31]NICCOLI G,RIGATTIERI S,DE VITA M R,et al.Openlabel,randomized,placebo-controlled evaluation of intracoronary adenosine or nitroprusside after thrombus aspiration during primary percutaneous coronary intervention for the prevention of microvascular obstruction in acute myocardial infarction:the REOPEN-AMI study(Intracoronary Nitroprusside Versus Adenosine in Acute Myocardial Infarction)[J].JACC Cardiovasc Interv,2013,6(6):580-589.DOI:10.1016/j.jcin.2013.02.009.
[32]ITO N,NANTO S,DOI Y,et al.Beneficial effects of intracoronary nicorandil on microvascular dysfunction after primary percutaneous coronary intervention:demonstration of its superiority to nitroglycerin in a cross-over study[J].Cardiovasc Drugs Ther,2013,27(4):279-287.DOI:10.1007/s10557-013-6456-y.
[33]DESCH S,SIEGEMUND A,SCHOLZ U,et al.Platelet inhibition and GPⅡb/Ⅲa receptor occupancy by intracoronary versus intravenous bolus administration of abciximab in patients with ST-elevation myocardial infarction[J].Clin Res Cardiol,2012,101(2):117-124.DOI:10.1007/s00392-011-0372-6.
[34]DE CATERINA A R,PORTO I,LUIGI DE MARIA G,et al.Prevention and treatment of coronary distal embolization in the setting of acute myocardial infarction:pharmacologic approach[J].Curr Vasc Pharmacol,2012,10(4):463-467.
[35]PATTI G,CANNON C P,MURPHY S A,et al.Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention:a collaborative patient-level meta-analysis of 13randomized studies[J].Circulation,2011,123(15):1622-1632.DOI:10.1161/CIRCULATIONAHA.110.002451.
[36]BAVRY A A,KUMBHANI D J,BHATT D L.Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction:a comprehensive meta-analysis of randomized trials[J].Eur Heart J,2008,29(24):2989-3001.DOI:10.1093/eurheartj/ehn421.
[2]NDREPEPA G,TIROCH K,KETA D,et al.Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction[J].Circ Cardiovasc Interv,2010,3(1):27-33.DOI:10.1161/CIRCINTERVENTIONS.109.896225.
[3]FREIXA X,HERAS M,ORTIZ J T,et al.Usefulness of endothelin-1 assessment in acute myocardial infarction[J].Rev Esp Cardiol,2011,64(2):105-110.DOI:10.1016/j.recesp.2010.07.001.
[4]EITEL I,NOWAK M,STEHL C,et al.Endothelin-1 release in acute myocardial infarction as a predictor of long-term prognosis and no-reflow assessed by contrast-enhanced magnetic resonance imaging[J].Am Heart J,2010,159(5):882-890.DOI:10.1016/j.ahj.2010.02.019.
[5]REINDL M,REINSTADLER S J,FEISTRITZER H J,et al.Relation of inflammatory markers with myocardial and microvascular injury in patients with reperfused ST-elevation myocardial infarction[J].Eur Heart J Acute Cardiovasc Care,2017,6(7):640-649.DOI:10.1177/2048872616661691.
[6]LEE M J,PARK S D,KWON S W,et al.Relation between neutrophil-to-lymphocyte ratio and index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Am J Cardiol,2016,118(9):1323-1328.DOI:10.1016/j.amjcard.2016.07.072.
[7]KIM M K,CHUNG W Y,CHO Y S,et al.Serum N-terminal proB-type natriuretic peptide levels at the time of hospital admission predict of microvascular obstructions after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction[J].J Interv Cardiol,2011,24(1):34-41.DOI:10.1111/j.1540-8183.2010.00606.x.
[8]FABREGAT-ANDRéSó,CUBILLOS A,FERRANDOBELTRáN M,et al.Mean platelet volume is associated with infarct size and microvascular obstruction estimated by cardiac magnetic resonance in ST segment elevation myocardial infarction[J].Blood Coagul Fibrinolysis,2013,24(4):424-427.DOI:10.1097/MBC.0b013e32835d9bca.
[9]MARENZI G,GIORGIO M,TRINEI M,et al.Circulating cytochrome c as potential biomarker of impaired reperfusion in STsegment elevation acute myocardial infarction[J].Am J Cardiol,2010,106(10):1443-1449.DOI:10.1016/j.amjcard.2010.07.014.
[10]OTA S,TANIMOTO T,ORII M,et al.Association between hyperglycemia at admission and microvascular obstruction in patients with ST-segment elevation myocardial infarction[J].J Cardiol,2015,65(4):272-277.DOI:10.1016/j.jjcc.2014.10.013.
[11]MARFELLA R,ESPOSITO K,GIUNTA R,et al.Circulating adhesion molecules in humans:role of hyperglycemia and hyperinsulinemia[J].Circulation,2000,101(19):2247-2251.
[12]MONTONE R A,NICCOLI G,MINELLI S,et al.Clinical outcome and correlates of coronary microvascular obstruction in latecomers after acute myocardial infarction[J].Int J Cardiol,2017,236:30-35.DOI:10.1016/j.ijcard.2017.02.023.
[13]CHOI S,JANG W J,SONG Y B,et al.D-dimer levels predict myocardial injury in ST-segment elevation myocardial infarction:a cardiac magnetic resonance imaging study[J].PLo S One,2016,11(8):e0160955.DOI:10.1371/journal.pone.0160955.
[14]LAYLAND J,NERLEKAR N,PALMER S,et al.Invasive assessment of the coronary microcirculation in the catheter laboratory[J].Int J Cardiol,2015,199:141-149.DOI:10.1016/j.ijcard.2015.05.190.
[15]DING S,LI Z,GE H,et al.Impact of early ST-segment changes on cardiac magnetic resonance-verified intramyocardial haemorrhage and microvascular obstruction in ST-elevation myocardial infarction patients[J].Medicine(Baltimore),2015,94(35):e1438.DOI:10.1097/MD.0000000000001438.
[16]ROMMEL K P,BADARNIH H,DESCH S,et al.QRS complex distortion(Grade 3 ischaemia)as a predictor of myocardial damage assessed by cardiac magnetic resonance imaging and clinical prognosis in patients with ST-elevation myocardial infarction[J].Eur Heart J Cardiovasc Imaging,2016,17(2):194-202.DOI:10.1093/ehjci/jev135.
[17]CAMICI P G,D'AMATI G,RIMOLDI O.Coronary microvascular dysfunction:mechanisms and functional assessment[J].Nat Rev Cardiol,2015,12(1):48-62.DOI:10.1038/nrcardio.2014.160.
[18]LEUNG D Y,LEUNG M.Non-invasive/invasive imaging:significance and assessment of coronary microvascular dysfunction[J].Heart,2011,97(7):587-595.DOI:10.1136/hrt.2009.183327.
[19]FRIEDRICH M G,KRAMER C M,SODICKSON D K,et al.Meeting highlights of the 10th annual scientific sessions of the Society for Cardiovascular Magnetic Resonance and 6th annual meeting of the Working Group for Cardiovascular Magnetic Resonance of the European Society of Cardiology:Rome,Italy,February 2-4,2007[J].J Am Coll Cardiol,2007,50(10):983-987.
[20]GUPTA S,GUPTA M M.No reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction[J].Indian Heart J,2016,68(4):539-551.DOI:10.1016/j.ihj.2016.04.006.
[21]HAMIRANI Y S,KRAMER C M.Cardiac MRI assessment of myocardial perfusion[J].Future Cardiol,2014,10(3):349-358.DOI:10.2217/fca.14.18.
[22]黄希.冠状动脉无复流现象的机制、诊断和防治进展[J].广西医科大学学报,2012,29(1):160-163.DOI:10.3969/j.issn.1005-930X.2012.01.069.
[23]AMIER R P,TEUNISSEN P F,MARQUES K M,et al.Invasive measurement of coronary microvascular resistance in patients with acute myocardial infarction treated by primary PCI[J].Heart,2014,100(1):13-20.DOI:10.1136/heartjnl-2013-303832.
[24]KLONER R A,GANOTE C E,JENNINGS R B.The"no-reflow"phenomenon after temporary coronary occlusion in the dog[J].J Clin Invest,1974,54(6):1496-1508.
[25]SCALONE G,AURIGEMMA C,TOMAI F,et al.Effect of preinfarction angina on platelet reactivity in acute myocardial infarction[J].Int J Cardiol,2013,167(1):51-56.DOI:10.1016/j.ijcard.2011.11.085.
[26]马晓静,张兴华,罗曼,等.缺血预适应与缺血后适应现象对急性心肌梗死急症介入治疗后的影响[J].中华医学杂志,2007,87(2):114-117.DOI:10.3760/j:issn:0376-2491.2007.02.011.
[27]ILIODROMITIS E K,GEORGIADIS M,COHEN M V,et al.Protection from post-conditioning depends on the number of short ischemic insults in anesthetized pigs[J].Basic Res Cardiol,2006,101(6):502-507.DOI:10.1007/s00395-006-0606-3.
[28]JANSEN VAN VUREN P,POTGIETER A C,PAWESKA J T,et al.Preparation and evaluation of a recombinant Rift Valley fever virus N protein for the detection of Ig G and Ig M antibodies in humans and animals by indirect ELISA[J].J Virol Methods,2007,140(1/2):106-114.DOI:10.1016/j.jviromet.2006.11.005.
[29]ABDELAZIZ H K,ELKILANY W,KHALID S,et al.Efficacy and safety of intracoronary verapamil versus sodium nitroprusside for the prevention of microvascular obstruction during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction[J].Coron Artery Dis,2017,28(1):11-16.DOI:10.1097/MCA.0000000000000423.
[30]GUARINI G,HUQI A,MORRONE D,et al.Pharmacological approaches to coronary microvascular dysfunction[J].Pharmacol Ther,2014,144(3):283-302.DOI:10.1016/j.pharmthera.2014.06.008.
[31]NICCOLI G,RIGATTIERI S,DE VITA M R,et al.Openlabel,randomized,placebo-controlled evaluation of intracoronary adenosine or nitroprusside after thrombus aspiration during primary percutaneous coronary intervention for the prevention of microvascular obstruction in acute myocardial infarction:the REOPEN-AMI study(Intracoronary Nitroprusside Versus Adenosine in Acute Myocardial Infarction)[J].JACC Cardiovasc Interv,2013,6(6):580-589.DOI:10.1016/j.jcin.2013.02.009.
[32]ITO N,NANTO S,DOI Y,et al.Beneficial effects of intracoronary nicorandil on microvascular dysfunction after primary percutaneous coronary intervention:demonstration of its superiority to nitroglycerin in a cross-over study[J].Cardiovasc Drugs Ther,2013,27(4):279-287.DOI:10.1007/s10557-013-6456-y.
[33]DESCH S,SIEGEMUND A,SCHOLZ U,et al.Platelet inhibition and GPⅡb/Ⅲa receptor occupancy by intracoronary versus intravenous bolus administration of abciximab in patients with ST-elevation myocardial infarction[J].Clin Res Cardiol,2012,101(2):117-124.DOI:10.1007/s00392-011-0372-6.
[34]DE CATERINA A R,PORTO I,LUIGI DE MARIA G,et al.Prevention and treatment of coronary distal embolization in the setting of acute myocardial infarction:pharmacologic approach[J].Curr Vasc Pharmacol,2012,10(4):463-467.
[35]PATTI G,CANNON C P,MURPHY S A,et al.Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention:a collaborative patient-level meta-analysis of 13randomized studies[J].Circulation,2011,123(15):1622-1632.DOI:10.1161/CIRCULATIONAHA.110.002451.
[36]BAVRY A A,KUMBHANI D J,BHATT D L.Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction:a comprehensive meta-analysis of randomized trials[J].Eur Heart J,2008,29(24):2989-3001.DOI:10.1093/eurheartj/ehn421.