Effect of Iron Chelation on Myocardial Infarct Size and Oxidative Stress in ST-Elevation-Myocardial Infarction
Effect of Iron Chelation on Myocardial Infarct Size and Oxidative Stress in ST-Elevation-Myocardial Infarction
复制标题
DOI：
10.1161/circinterventions.111.966226
复制
发表时间：
2012-04-01
影响因子：
5.6
通讯作者：
Duffy, Stephen J.
中科院分区：
文献类型：
--
作者：
Chan, William;Taylor, Andrew J.;Duffy, Stephen J.
背景-实验研究表明，去铁胺（DFO）通过螯合氧化还原活性铁限制活性氧的产生，从而可能减少缺血再灌注损伤和心肌梗死（MI）的范围。我们研究了直接经皮冠状动脉介入治疗（PPCI）再灌注前给予DFO是否会改善氧化应激和MI大小。方法和结果-我们随机分配了60名ST段抬高型MI患者，在PPCI前立即接受DFO（500 mg）静脉推注，随后输注12小时（50 mg/kg体重）（n=28）或生理盐水推注和输注（安慰剂组，n=32）。通过对比增强心脏MRI（CMRI;第3 +/- 1天）、肌酸激酶和肌钙蛋白I曲线下面积以及超声心动图室壁运动异常的严重程度测量MI大小。在3个月（100 ± 17天）时进行临床随访，包括重复CMRI和超声心动图。通过血浆F-2-异前列烷水平评估氧化应激。DFO组和安慰剂组在基线特征、症状和上门球囊时间、PPCI前冠状动脉通畅率和梗死相关动脉位置方面平衡良好。与安慰剂相比，PPCI后DFO治疗组血清铁水平降低（3.0 +/- 2.5 vs 12.6 +/- 5.5 μ mol/L，P
Background-Experimental studies suggest that deferoxamine (DFO) limits the generation of reactive oxygen species by chelating redox-active iron and thereby may reduce ischemia-reperfusion injury and myocardial infarct (MI) size. We investigated whether DFO administered before reperfusion by primary percutaneous coronary intervention (PPCI) would ameliorate oxidative stress and MI size.Methods and Results-We randomly assigned 60 patients with ST-elevation-MI to receive an intravenous bolus of DFO (500 mg) immediately before PPCI followed by a 12-hour infusion (50 mg/kg of body weight) (n=28) or normal saline bolus and infusion (placebo group, n=32). MI size was measured by contrast-enhanced cardiac MRI (CMRI; day 3 +/- 1), creatine kinase and troponin I area-under-the-curve, and severity of wall motion abnormality on echocardiography. Clinical follow-up including repeat CMRI and echocardiography were performed at 3 months (100 +/- 17 days). Oxidative stress was assessed by plasma F-2-isoprostane levels. DFO and placebo groups were well balanced with respect to baseline characteristics, symptom- and door-to-balloon times, pre-PPCI coronary patency, and infarct-related artery location. Serum iron levels were decreased with DFO treatment after PPCI compared with placebo (3.0 +/- 2.5 versus 12.6 +/- 5.5 mu mol/L, P