前部STセグメント上昇心筋梗塞の患者における再注射前に左心室の解荷
Navin K Kapur1, Mohamad A Alkhouli2, Tony J DeMartini
1The CardioVascular Center, Tufts Medical Center, Boston, MA (N.K.K., R.H.K., C.D.K., J.E.U.).
Circulation
|December 28, 2018
まとめ
STセグメント上昇性心筋梗塞 (STEMI) で再注射する前に,左心室 (LV) を機械的に放出することは安全で実行可能である. この試験試験では,LVの放出が心臓発作の大きさを制限する可能性があることが示唆され,より大きな試験でさらなる調査が必要である.
科学分野:
- 心臓病科
- 介入心臓科
- 急性心筋梗塞の研究
背景:
- STセグメント上昇心筋梗塞 (STEMI) の心臓発作の大きさは,心不全と死亡率に直接影響を及ぼします.
- 臨床前研究では,再注射前に左心房 (LV) の機械的な放出が心臓発作のサイズを小さくし,心臓保護経路を活性化することを示しています.
- DTU- STEMI試験は,心臓発作性ショックのないSTEMI患者で,LVの放出と遅延再注血の安全性と実現可能性を初めて調査したものです.
研究 の 目的:
- 前部STEMI患者のインペラCP装置を用いた左心室 (LV) のメカニカル解荷の安全性と可行性を評価する.
- 直ちに再注射するよりも,30分間のLVの放出期間と再注射による心臓発作の大きさの影響を評価する.
- STEMI患者において,再注射前にLVの放出が安全な戦略であるかどうかを判断する.
主な方法:
- 50人の前置性STEMI患者を対象とした多センター,前置性,ランダム化調査安全性および可行性試験.
- 患者は,インペラ CPを用いて,直送再注血 (U- IR) または30分後の遅延再注血 (U- DR) に割り当てられました.
- 主要安全性エンドポイントは30日後に発生した主要な心血管および脳血管疾患の複合体であり,心臓発作の大きさはMRIで評価された.
主要な成果:
- すべての50人の患者は,割り当てられたプロトコル (U- IR,n=25;U- DR,n=25) を完了し,ドアから気球までの平均時間はそれぞれ72分と97分でした.
- U- IR (8%) と U- DR (12%) グループ間の主要な心血管および脳血管疾患の発生率に統計的に有意な差はありません (P=0. 99).
- 30分後に再注血を延期することは,即時の再注血と比較して30日間の平均心臓発作の大きさに有意な影響を及ぼさなかった (13%対15%のLV質量,P=0. 53).
結論:
- インペラ・CP装置によるメカニカルなLVの放出,再注血の前に30分間の遅延は,前部STEMI患者で合理的な時間枠内で実行可能である.
- DTU-STEMIの試験試験では,より大きなピボタル研究を妨げるような安全性に関する懸念は明らかにされなかった.
- STEMI治療の現在の標準治療と再注射前のLVの放出を比較するために,パワード・ピボタル試験におけるさらなる調査が必要である.
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