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Acute Coronary Syndrome IV: Interprofessional Care01:28

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STセグメント上昇性心筋梗塞に対する初回皮経冠動脈介入を受ける患者におけるN- アセチルシステインの早期使用は,心筋梗塞のサイズを減らす (NACIAM試験 [急性心筋梗塞におけるN- アセチルシステイン])

Sivabaskari Pasupathy1, Rosanna Tavella1, Suchi Grover1

  • 1From Discipline of Medicine, University of Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., Y.T.D., G.M., C.Z., M.A., J.D.H., J.F.B); Basil Hetzel Institute for Translational Health Research, Adelaide, Australia (S.P., R.T., B.R., N.E.K.P., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Central Adelaide Local Health Network, Australia (S.P., R.T., B.R., N.E.K.P., Y.D., G.M., I.S., T.H., A.H., C.Z., J.D.H., J.F.B); Northern Adelaide Local Health Network, Australia (G.M., C.Z., M.A., J.F.B.); Southern Adelaide Local Health Network, Australia (S.G., J.S.); Discipline of Medicine, Flinders University, Adelaide, Australia (S.G., J.S.); and South Australian Health and Medical Research Institute, Adelaide, Australia (J.S.).

Circulation
|June 22, 2017
PubMed
まとめ

N- アセチルシステイン (NAC) をニトログリセリンと併用すると,皮経冠動脈手術を受けた患者の心臓発作のサイズが減少しました. この組み合わせ治療は,ST上昇性心筋梗塞の患者の治療結果を改善すると有望である.

キーワード:
ST上昇心筋梗塞アセチルシステイン心筋梗塞心筋再注血による損傷ニトログリセリン経皮冠動脈介入

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科学分野:

  • 心臓病科
  • 薬理学について

背景:

  • 現代的なSTセグメント上昇心筋梗塞 (STEMI) 管理は,一次性皮経冠動脈干渉 (PCI) に依存しています.
  • PCIを受けたSTEMI患者の心臓発作の大きさをさらに減らすための補助療法が研究されている.
  • 抗酸化物質であるN-アセチルシステイン (NAC) は,ニトログリセリンを強化し,STEMIの潜在的な補助療法です.

研究 の 目的:

  • パーキュタヌス冠動脈介入 (PCI) を受けているSTセグメント上昇心筋梗塞 (STEMI) の患者の心筋梗塞のサイズを減らすための補助療法として,N- アセチルシステイン (NAC) の有効性を評価する.

主な方法:

  • ランダム化,ダブルブラインド,プラセボ制御,多センター試験 (NACIAM) で,112人のSTEMI患者で初回PCIを受けた.
  • 患者は高用量の静脈内NAC (2日間にわたって29g) またはプラセボを投与され,両方の背景には低用量のニトログリセリンが投与された.
  • 心臓磁気共鳴画像 (CMR) を用いて心臓発作の大きさを評価した.

主要な成果:

  • 早期のCMRを受けた75人の患者のうち,NACにランダムに割り当てられた患者は,プラセボと比較して心臓発作のサイズを5. 5%減少させた (11. 0%対16. 5%,P=0. 02).
  • NACグループでは心筋回復が有意に改善された (60%対27%,P<0. 01).
  • 曲線の下のクレアチンキナーゼ領域の中央値はNAC群で低かった (22,000 IU·h vs 38,000 IU·h,P=0. 08).

結論:

  • 高用量静脈内投与のNACと低用量静脈内投与のニトログリセリンは,プライマリPCIを受けたSTEMI患者における心臓発作の大きさを有意に減少させる.
  • これらの発見は,STEMIの管理における補助療法としてのNACの潜在的な利益を示唆しています.
  • 臨床的な心臓の結果への影響を確認するために,より大きな研究が必要である.