冠状动脉支架 (CRISP支架) 中的心脏远程缺血预调研究:一个前性的随机对照试验
Stephen P Hoole1, Patrick M Heck, Linda Sharples
1Department of Cardiology, Papworth Hospital, Papworth Everard, UK.
Circulation
|February 4, 2009
概括
远程缺血预调 (IPC) 显著降低了穿皮冠状动脉干预 (PCI) 期间心脏中托罗邦素I的释放和胸部不适. 这种保护作用还降低了六个月后主要的不良心脏和大脑事件.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 缺血预先调节 缺血预先调节
背景情况:
- 肌细胞亡发生在接受选择性穿皮冠状动脉干预 (PCI) 的患者中约三分之一.
- 这种亡与随后心血管事件的增加有关.
- 远程缺血预制 (IPC) 被研究为一种减少PCI期间心脏损伤的方法.
研究的目的:
- 评估远程IPC在选择性PCI后减弱心脏托罗邦素I (cTnI) 释放的疗效.
- 评估远程IPC对二次结果 (如功能障碍和主要心脏和大脑不良事件 (MACCE)) 的影响.
主要方法:
- 二百四十二名接受选择性PCI的患者被随机分配到接受远程IPC或假控制.
- 远程IPC涉及在手术前5分钟间隔在上臂上充气血压袖口.
- 在PCI后24小时测量了心脏类素I水平,在6个月后评估了次要结果.
主要成果:
- 24小时后的中位数cTnI水平在远程IPC组 (0.06 ng/mL) 与对照组 (0.16 ng/mL;P=0.040) 相比显著较低.
- 远程IPC组中较高比例的患者的cTnI水平低于0.04 ng/mL (42%对24%;P=0.01).
- 远程IPC与胸部不适减少 (P=0.0006),ECG ST段偏差减少 (P=0.005),以及6个月后MACCE率降低 (4对13次事件;P=0.018).
结论:
- 远程缺血预调可以有效地减少选择性PCI后心脏中素I的释放.
- IPC可以缓解与手术相关的缺血性胸部不适和心电图变化.
- 这些发现表明,远程IPC可能会减少长期的不良心血管和大脑事件.
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