Initial reduction of oxidative stress by angiotensin receptor blocker contributes long term outcomes after percutaneous coronary intervention.
Initial reduction of oxidative stress by angiotensin receptor blocker contributes long term outcomes after percutaneous coronary intervention.
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发表时间：
2014-12
影响因子：
1.3
通讯作者：
Tadanori Noro;N. Takehara;K. Sumitomo;Toshiharu Takeuchi;Yoshinao Ishii;Junichi Kato;J. Kawabe;N. Hasebe
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文献类型：
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作者：
Tadanori Noro;N. Takehara;K. Sumitomo;Toshiharu Takeuchi;Yoshinao Ishii;Junichi Kato;J. Kawabe;N. Hasebe
目前尚不清楚具有活性氧（ROS）清除作用的ARB是否能改善接受PCI的患者的预后。本研究调查了血管紧张素受体阻滞剂（ARB）的干预前抗氧化作用是否影响成功经皮冠状动脉介入治疗（PCI）后无早期不良事件的患者的长期结局。方法52例择期PCI患者随机分为接受或不接受ARB治疗组，ARB在PCI前48 h内给药。分别于术前及术后6个月检测外周血单个核细胞（MNCs）活性氧（ROS）水平及血清超氧化物歧化酶（SOD）活性。在排除血管造影随访期间的非预期早期不良事件后，评估合格患者的长期结局（主要不良心血管事件; MACCE）。结果43例患者（非ARB n = 22，ARB n = 21）在本研究中得到随访。在血管造影随访期间，与ARB组相比，非ARB组的MNC中ROS形成显著增加（从29.4 [21.6-35.2]至37.2 [30.7-45.1]任意单位; p = 0.031）。同时，非ARB单独给药组的SOD活性显著受损（从24.0 ± 17.0%降至16.3 ± 13.8%，p = 0.004）。在随访期间（中位数，63.3个月），在6例患者中观察到MACE。非ARB组的MACCE累积事件比率显著高于ARB组（p = 0.018）。结论：在血管造影随访期间，ARB可有效降低PCI患者的ROS产生。ARB给药后的初始ROS抑制可能有助于改善成功接受PCI的患者的不良结局。
BACKGROUND It remains unclear whether administration of ARB with reactive oxygen species (ROS) scavenging effects improves the prognosis of patients undergoing PCI. OBJECTIVES This study investigated whether the pre-intervention antioxidant effect of angiotensin receptor blocker (ARB) affects long-term outcomes in patients after successful percutaneous coronary intervention (PCI) without early adverse events. METHODS Fifty-two patients who underwent elective PCI were randomly assigned for treatment with or without ARB, which was administered within 48 hours before PCI. ROS levels in mononuclear cells (MNCs) and serum superoxide dismutase (SOD) activity were measured pre-PCI and 6 months post-PCI. After exclusion of unexpected early adverse events during angiographic follow-up period, the long-term outcome (major adverse cerebro-cardiovascular event; MACCE) was assessed in eligible patients. RESULTS Forty-three patients (non-ARB n = 22, ARB n = 21) were followed up in this study. During angiographic follow-up period, ROS formation in MNCs was significantly increased in the non-ARB group (from 29.4 [21.6-35.2] to 37.2 [30.7-45.1] arbitrary units; p = 0.031) compared to that in the ARB group. Meanwhile, SOD activity was significantly impaired in the non-ARB group alone (from 24.0 ± 17.0 to 16.3 ± 13.8%, p = 0.004). During the follow-up period (median, 63.3 months), MACCEs were observed in 6 patients. The cumulative event ratio of MACCE was significantly higher in the non-ARB group than in the ARB group (p = 0.018). CONCLUSIONS Concomitant administration of ARB effectively reduced ROS production of PCI patients during angiographic follow-up period. Initial ROS inhibition following ARB administration may contribute to improvement of worse outcomes in patients who have undergone successful PCI.