经皮冠状动脉介入治疗对急性心肌梗死患者左心室重构的影响

目的 探讨急性心肌梗死(acute myocardial infarction,AMI)患者行经皮冠状动脉介入(percutaneous coro-nary intervention,PCI)治疗后血清基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)和金属蛋白酶组织抑制因子1(tis...

Effect of Percutaneous Coronary Intervention on Left Ventricular Remodeling after Acute Myocardial Infarction

Objective To investigate the effect of primary percutaneous coronary intervention（PCI） on serum matrix metalloproteinase-9（MMP-9）,tissue inhibitors of metalloproteinase-1（TIMP-1） and left ventricular remodeling（LVRM） after acute myocardial infarction（AMI）.Methods Ninety-eight patients with the first-episode AMI were enrolled.Fifty-one patients（group A） underwent direct PCI within 12 hours after the onset.Twenty-two patients（group B） underwent delayed PCI 12 hours after the onset when their status was stable.The other 25 patients（group C） accepted conservative therapy.Twenty patients without obvious local stenosis examined by coronary angiography were as control group（group D）.Serum MMP-9 and TIMP-1 were measured by enzyme-linked immunosorbent assay（ELISA）.End diastolic volume（EDV）,end systolic volume（ESV）,left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter（LVDd） and ventricular aneurysm were evaluated by two dimensional echocardiogram.Results Serum MMP-9 concentration in group A was increased after PCI and decreased near to the normal level at 7 days after the disease onset,which was significantly different from groups B and C（P〈0.05）.The EDV,ESV,LVDd and LVEF levels at 90 days after the disease onset in groups A and B were significantly better than group C（P〈0.05）.The average serum level of MMP-9 at 7 days were positively correlated with EDV（r=0.261,P〈0.05）,ESV（r=0.340,P〈0.05） and negatively correlated with LVEF（r=-0.218,P〈0.05） at 90 days after the disease onset.Conclusion Serum MMP-9 in AMI patients rises early after PCI.During LYRM,the average serum MMP-9 levels are positively correlated with EDV and ESV levels,and negatively correlated with LVEF.Direct PCI and delayed PCI can prevent left ventricular remodeling and improve heart function.