通过皮肤冠状动脉干预后电心图无回流的ST升高心肌梗塞患者的声热溶解:随机对照试验
Soufiane El Kadi1, Mariëlle C van de Veerdonk1, Eva M Spoormans1
1Amsterdam UMC, Location VUmc, Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
概括
在PCI后的声溶解没有改善ST分辨率,也没有减少持续ST升高的STEMI患者的心脏病发作的大小. 这种干预措施没有显著影响这个高风险组的临床结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 生物医学工程 生物医学工程
背景情况:
- 通过皮肤冠状动脉干预 (PCI) 后,ST升高心肌梗塞 (STEMI) 通常涉及微血管无反流.
- 声热溶解在减少心脏病发作的大小和改善STEMI患者的左心室功能方面显示出潜力.
- 在PCI后持续的ST升高表明正在进行的心肌损伤和风险.
研究的目的:
- 为了评估PCI后声溶解在持续ST升高的STEMI患者的疗效.
- 确定声热溶解能否降低该特定患者亚组的无逆流和心脏病发作大小.
- 评估对ST分辨率,心肌输液和临床结果的影响.
主要方法:
- 随机对照试验涉及STEMI患者,在初级PCI后出现<12小时的症状和持续的ST升高.
- 患者被随机分配,接受声热溶解或标准护理 (对照).
- 主要终点:在60分钟内总结ST升高;次要终点:心脏病发作大小,输液,LV功能以及通过CMR和随访的6个月临床结果.
主要成果:
- 在声热溶解和对照组之间,总计ST升高没有显著差异 (P=.50).
- 完整的ST解析率没有显著差异 (40%与19%,P=.16).
- 心脏病发作的大小,心肌输液,LV喷射率和6个月的临床结果在两组之间是可比的.
结论:
- 在PCI后的声溶解没有改善ST分辨率,也没有减少持续ST升高的STEMI患者的心脏病发作的大小.
- 在这个高风险人群中,重大不良临床事件的发生率很低.
- 可能需要进一步的研究来确定最佳策略来管理PCI后持续的ST升高.
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