Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis

Introduction: Nicorandil may exert cardioprotective effects in ischemic heart disease. However, its efficacy in combination with early reperfusion is uncertain. The authors performed a meta-analysis of the short- and long-term clinical outcomes of nicorandil administration at the time of primary percutaneous coronary intervention (PCI) in patients with ST-elevated myocardial infarction (STEMI).

Methods: PubMed, MEDLINE, Embase, and the Cochrane Library databases were systematically searched for eligible randomized controlled studies. The primary endpoint was major adverse cardiovascular events (MACE), both in-hospital and post-discharge. The secondary endpoint was the incidence of no-reflow phenomenon.

Results: Ten studies were included (n = 1105). Mean patient age was 63.0 ± 10.0 years; 76.6% of patients were male. Compared with controls who received primary PCI, combined nicorandil/primary PCI significantly reduced in-hospital MACE (pooled odds ratio [OR] 0.16; 95% confidence interval [CI] 0.09–0.27), follow-up MACE (pooled OR 0.53; 95% CI 0.37–0.75), and total MACE (pooled OR 0.27; 95% CI 0.15–0.49). The combined treatment also reduced the incidence of no-reflow phenomenon (pooled OR 0.34; 95% CI 0.23–0.50).

Conclusion: Nicorandil administration at the time of primary PCI is associated with reduced MACE (both short- and long-term) and no-reflow phenomenon in patients with STEMI.     

微血管损伤对急性心肌梗死患者的影响

心肌梗死患者即使心外膜冠状动脉血流得以成功恢复,仍有相当比例的患者受到严重的微血管灌注损伤,且除外主动脉夹层、栓塞、痉挛及狭窄等原因,这种心肌组织仍低灌注的现象称为无复流或微血管损伤.其潜在的病理生理学机制可能是复杂的、多因素的.微循环损伤的发生是影响心肌梗死患者预后的相关因素,且其个体差异性较大,目前尚未建立完善有效的防治策略.迄今为止大多数临床研究结果都不尽如人意,进行深入研究以减少或避免微血管损伤带来的影响是目前急需解决的关键问题.     

血浆血栓素A2/前列腺素I2值与骨骼肌无复流现象

背景：在骨骼肌无复流现象中血栓素A2及前列腺素I2是重要参与因子。 目的：观察下肢动脉栓塞患者血浆血栓素A2/前列腺素I2值与骨骼肌发生无复流现象的关系。 方法：选择经影像学及临床表现确诊为下肢动脉栓塞患者36例,行下肢动脉取栓,根据患者取栓后缺血肢体是否发生无复流现象分为无复流组(n=10)和对照组(n=26)。 结果与结论：与对照组比较,无复流组取栓后0 h无复流组前列腺素I2明显减少(P < 0.01);取栓后24 h,无复流组血栓素A2明显升高、前列腺素I2明显下降(P < 0.01)。与对照组相比,无复流组术后血栓素A2/前列腺素I2值升高(P < 0.05)。与术前相比,对照组术后血栓素A2/前列腺素I2值升高后然后下降,无复流组取栓后均维持较高的水平。而取栓前后两组血小板数量及血浆纤维蛋白原的水平差异均无显著性意义。同时术后24 h点无复流组血栓素A2/前列腺素I2值与纤维蛋白原呈正相关(r=0.613, P=0.049);而与血小板数量无相关性(r=0.199,P=0.543)。提示血栓素A2/前列腺素I2值可以作为判断动脉栓塞患者缺血再灌注后骨骼肌发生无复流现象的指标之一。     

IL-17和ICAM-1在大鼠急性心肌缺血再灌注后无复流现象中的表达

目的 探讨前炎症因子白介素-17( interelenkin-17,IL-17)与细胞间黏附因子-1(intercellular adhesion molecule-1,ICAM-1)在大鼠急性心肌缺血再灌注后无复流现象中的表达.方法 Wistar大鼠12只,随机分成2组:假手术组、损伤组,每组6只.损伤组给予冠状动...     

The no-reflow phenomenon: A basic mechanism of myocardial ischemia and reperfusion

Both animal models of experimental myocardial infarction and clinical studies on reperfusion therapy for acute myocardial infarction have provided evidence of impaired tissue perfusion at the microvascular level after initiation of reperfusion despite adequate restoration of epicardial vessel patency. Characteristics of this “no-reflow” phenomenon found in basic science investigations, such as distinct perfusion defects, progressive decrease of resting myocardial flow with ongoing reperfusion and functional vascular alterations are paralleled by clinical observations demonstrating similar features during the course of reperfusion. In experimental animal investigations of coronary occlusion and reperfusion, this no-reflow phenomenon could be characterized as a fundamental mechanism of myocardial ischemia and reperfusion. Major determinants of the amount of no-reflow are the duration of occlusion, infarct size, but also the length of reperfusion, as rapid expansion of perfusion defects occurs during reperfusion. Moreover, no-reflow appears to persist over a period of at least four weeks, a period when major steps of infarct healing take place. The significant association of the degree of compromised tissue perfusion at four weeks and indices of infarct expansion, found in chronic animal models of reperfused myocardial infarction, might be the pathoanatomic correlate for the prognostic significance observed in the clinical setting.     

Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention

We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) in primary percutaneous coronary intervention (pPCI). Patients (n?=?440) with acute myocardial infarction (AMI) who underwent pPCI were divided into 2 groups: low PLR (<137) and high PLR (>137). “Thrombolysis In Myocardial Infarction” (TIMI) flow grades and Syntax scores (SXS) were calculated from initial angiograms. In-hospital mortality rate and cardiac adverse events were obtained from medical records. Patients with high PLR had more no-reflow, higher SXS and higher mortality rate (p?<?0.001, p?<?0.001 and p?=?0.008, respectively). In receiver operating characteristic curve analysis, high PLR predicted development of no-reflow (specificity 71% and sensitivity 85%), SXS>22 (specificity 52% and sensitivity 61%) and adverse events (specificity 67% and sensitivity 63%). In multivariate regression analysis, PLR was an independent risk factor for no-reflow, SXS>22 and in-hospital adverse events. In addition to PLR, we present the relationship between mean platelet volume, red cell distribution width and neutrophil to lymphocyte ratio and no-reflow, SXS and in-hospital adverse events.     

阿托伐他汀对ST段抬高型急性心肌梗死患者急诊PCI术后无复流现象的影响

目的:探讨长期应用阿托伐他汀对冠状动脉介入治疗(PCI)术后无复流发生率的影响。方法:入选对象均为ST段抬高型急性心肌梗死(STEMI)患者,接受急诊PCI治疗且至少口服阿托伐他汀10mg/d3个月以上者入选阿托伐他汀组,未服用任何调脂药物者入选对照组,连续入选,至每组60例为止。PCI术中根据TI-MI血流分级法(TFG)、TIMI计帧法(cTFC)评价冠状动脉血流。术后24h进行实时心肌声学造影检查,计算心肌灌注缺损计分指数(CSI)及室壁运动计分指数(WMSI)。术后30min及24h记录心电图,观察ST段抬高最显著导联ST段回落的情况。术前、术后24h采取静脉血测定血浆高敏C反应蛋白(Hs-CRP)及sICAM-1水平。结果:阿托伐他汀组TIMI3级血流者显著多于对照组(P<0.05),而cTFC显著低于对照组(P<0.01)。阿托伐他汀组与对照组相比CSI(1.22±0.33:1.37±0.42,P<0.05),WMSI(1.53±0.40:1.71±0.38,P<0.05)均显著降低。术后30min阿托伐他汀组ST段回落≥50%者显著多于对照组(P<0.05),术后24h差异无统计学意义。术前、术...     

替罗非班在老年人急诊经皮冠状动脉介入治疗中预防无复流的临床观察

目的观察老年人急诊PCI术中冠状动脉内注射替罗非班对术后无复流的影响。方法选择急性心肌梗死行急诊PCI患者163例,随机分为替罗非班组(83例)和对照组(80例)。替罗非班组在导丝通过病变后经导管冠状动脉内注射替罗非班10μg/kg,之后予替罗非班0.15μg/(kg·min)持续静脉滴注24 h。对照组给予常规治疗。观察2组患者TIMI、心肌灌注分级(TMPG),入院后30 d LVEF和左心室舒张末内径,心血管事件及出血并发症。结果替罗非班组TIMI血流3级和TMPG 2～3级比例较对照组明显升高,TIMI血流0～2级和TMPG 0～1级比例较对照组明显降低,差异有统计学意义(P<0.05)。替罗非班组LVEF较对照组明显改善,主要心血管事件较对照组明显降低,差异有统计学意义(P<0.05)。结论急诊PCI术中冠状动脉内注射替罗非班减少无复流,改善心肌灌注和心功能,且不增加心血管事件和并发症。