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La isquemia breve antecedente aumenta la trombólisis coronaria inducida por el activador de plasminógeno del tejido
1Heart Institute, Good Samaritan Hospital, Department of Medicine, University of Southern California, Los Angeles 90017-2395, USA. karinp@dnamail.com
Circulation
|July 6, 2000
Resumen
La angina de preinfarto, o una breve isquemia/reperfusión, acelera la trombolisis y reduce la reoclusión. La liberación de adenosina durante este proceso es clave para mejorar la permeabilidad de la arteria coronaria después del tratamiento.
Área de la Ciencia:
- Investigaciones Cardiovasculares Investigación Cardiovascular Investigaciones Cardiovasculares
- La trombosis y la trombólisis.
- Biología de la Isquemia-Reperfusión Biología de la Isquemia-Reperfusión
Sus antecedentes:
- Los estudios clínicos sugieren que la angina de pecho preinfarto (isquemia breve / reperfusión) predice una trombolisis más rápida y menos reoclusión.
- El impacto preciso de la isquemia antecedente en la eficacia trombolítica sigue siendo poco investigado.
- Investigar el papel de la adenosina en la mediación de estos efectos es crucial.
Objetivo del estudio:
- Reproducir los hallazgos clínicos sobre la angina de pecho preinfarto en un modelo canino.
- Para determinar si la liberación de adenosina durante una breve isquemia/reperfusión mejora la eficacia de la trombólisis.
- Evaluar el impacto en la permeabilidad de las arterias coronarias y las tasas de reoclusión.
Principales métodos:
- Se utilizó un modelo canino de trombosis coronaria, comparando una breve isquemia / reperfusión (I / R) con una perfusión ininterrumpida (controles).
- Se administró activador de plasminógeno de tejido recombinante para evaluar el tiempo hasta la lisis y la patencia.
- El estudio se repitió con el pretratamiento del antagonista de la adenosina A(2) / A(1) CGS 15943.
Principales resultados:
- El tiempo hasta la lisis se aceleró significativamente en el grupo I/R (11+/-1 min) frente a los controles (35+/-6 min).
- El grupo I / R mostró una duración reducida de la reoclusión (17 + / -12 minutos) y un aumento del área del perfil de tiempo de flujo (64 + / -12%).
- Con CGS 15943, el tiempo de lisis y la permeabilidad fueron comparables entre I/R y los grupos de control, lo que indica un efecto mediado por adenosina.
Conclusiones:
- La isquemia / reperfusión antecedente breve mejora significativamente la eficacia de la trombólisis coronaria en un modelo canino.
- La liberación de adenosina durante la isquemia / reperfusión juega un papel importante en la mejora de los resultados trombolíticos.
- Estos hallazgos apoyan las observaciones clínicas y aclaran un mecanismo subyacente clave.
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