在前部ST段升高心肌梗塞患者的再输血前卸载左心室
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
概括
在ST段升高心肌梗塞 (STEMI) 中,在再注血之前,机械地卸载左心室是安全的和可行的. 这项试点研究表明, LV 卸载可能会限制心脏病的大小,因此需要在更大规模的试验中进行进一步的研究.
科学领域:
- 心脏病学
- 干预心脏病学
- 急性心肌梗塞研究
背景情况:
- 在ST段升高心肌梗塞 (STEMI) 中,心脏病发作的大小直接影响心力衰竭和死亡率.
- 临床前研究表明,在再输血之前,机械左心室 (LV) 卸载可以减少心脏病发作的大小,并激活心脏保护通路.
- 这项DTU- STEMI试验是第一个在没有心脏性休克的情况下对LV卸载和延迟再注血的安全性和可行性进行研究的试验.
研究的目的:
- 评估使用Impella CP装置在前部STEMI患者中机械左心室 (LV) 卸载的安全性和可行性.
- 评估30分钟的 LV 卸载期,然后再输血对心脏病大小的影响,与即时输血相比.
- 确定在再注血之前卸载LV是否是STEMI患者的安全策略.
主要方法:
- 一个多中心,前性,随机的探索性安全性和可行性试验,涉及50名先前的STEMI患者.
- 患者被分配到使用Impella CP的立即再注血 (U- IR) 或30分钟后的延迟再注血 (U- DR).
- 主要安全终点是30天内主要心血管和脑血管不良事件的组合;心脏MRI评估了心脏病发作的大小.
主要成果:
- 所有50名患者完成了指定的方案 (U- IR,n=25;U- DR,n=25),平均门到气球的时间分别为72分钟和97分钟.
- 在U- IR (8%) 和U- DR (12%) 组之间,主要心血管和脑血管不良事件发生率没有统计学意义上的差异 (P=0. 99).
- 与立即输血相比,延迟输血30分钟后的输血并没有显著影响30天内心脏病的平均大小 (13%对15%的输血量,P=0. 53).
结论:
- 在合理的时间内,在前部STEMI患者中,可以使用Impella CP装置进行机械LV卸载,然后再输血30分钟.
- DTU-STEMI试验没有显示出安全问题,这将阻止更大规模的关键研究.
- 需要在动力关键试验中进行进一步的研究,以比较在再输血之前的LV卸载与当前的STEMI治疗标准.
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