Preinfarction angina reduces infarct size in ST-elevation myocardial infarction treated with percutaneous coronary intervention.
Preinfarction angina reduces infarct size in ST-elevation myocardial infarction treated with percutaneous coronary intervention.
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DOI：
10.1161/circinterventions.112.973164
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发表时间：
2013-02
期刊：
影响因子：
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通讯作者：
Traverse JH
中科院分区：
文献类型：
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作者：
Reiter R;Henry TD;Traverse JH
梗死前心绞痛可作为缺血预处理的临床替代，在ST段抬高型心肌梗死（STEMI）溶栓治疗的背景下，缺血预处理可减少梗死面积并提高死亡率。然而，由于梗死前心绞痛在梗死动脉通畅性和再灌注速度方面的成就更大，因此在直接PCI和支架植入术中的获益尚不确定。为了确定一个同质的人群，我们对1031例首次入院的STEMI患者进行了回顾性分析，缺血时间在1到6小时之间，接受了直接PCI。我们确定了245例动脉闭塞的患者，其中79例患者记录了梗死前心绞痛，定义为梗死后24小时内的胸痛。冠状动脉的大小被测量为峰值CK水平，一个指标在一个亚组中得到心脏MRI晚期增强的支持。与无梗死前心绞痛的患者（n=166）相比，梗死前心绞痛患者（n=79）的梗死面积减少了50%，（1094 ± 75 IU/L vs. 2270 ± 102 IU/L，p<0.0001）和CK曲线下面积（18，420 ± 18，941 vs. 36，810 ± 21，741 IU-hr / L，p <0.0001），尽管缺血时间相同（185 ± 8 min vs 181 ± 5 min，p=0.67）和血管造影风险面积（24.1 ± 1.2% vs 25.3 ± 0.9%，p=0.43）。有梗死前心绞痛的患者出院前左室射血分数绝对改善4%（p < 0.02）。梗死前心绞痛的发生与STEMI期间直接PCI和支架植入术的显著心肌保护相关。由于梗死前心绞痛相对常见，因此在研究旨在减少再灌注损伤和梗死面积的治疗的临床试验中识别这些患者是很重要的。
Pre-infarction angina may act as a clinical surrogate of ischemic preconditioning that may reduce infarct size and improve mortality in the setting of thrombolytic therapy for ST-elevation myocardial infarction (STEMI). However, the benefits of pre-infarction angina in the setting of primary PCI with stenting is inconclusive due to the greater achievement of infarct artery patency and speed of reperfusion. To identify a homogeneous population, we performed a retrospective analysis of 1031 patients admitted with a first STEMI with ischemic times between 1 and 6 hours who received primary PCI. We identified 245 patients who had occluded arteries on presentation of which 79 patients had documented pre-infarction angina defined as chest pain within 24 hours of infarction. Infarct size was measured as the peak CK level, a metric supported in a subgroup by late enhancement on cardiac MRI. Patients with pre-infarction angina (n=79) had a 50% reduction in infarct size compared to those patients without pre-infarction angina (n=166) by both peak CK (1094 ± 75 IU/L vs. 2270 ± 102 IU/L, p<0.0001) and CK area-under-curve (18,420 ± 18,941 vs. 36,810 ± 21,741 IU-hr / L, p <0.0001) despite having identical ischemic times (185 ± 8 min vs 181 ± 5 min, p=0.67) and angiographic area-at-risk (24.1 ± 1.2% vs. 25.3 ± 0.9%, p=0.43). There was an absolute 4% improvement in left-ventricular ejection fraction prior to discharge in those patients with pre-infarction angina (p < 0.02). The occurrence of pre-infarction angina is associated with significant myocardial protection in the setting of primary PCI with stenting during STEMI. Because pre-infarction angina is relatively common, it is important that these patients be identified in clinical trials investigating therapies designed to reduce reperfusion injury and infarct size.