经皮腔内冠状动脉成形术和支架术后心肌微损伤对近期临床预后的影响

目的 :通过观察血清肌钙蛋白I(cTnI)和肌酸激酶 同工酶 (CK MB)的变化 ,了解经皮腔内冠状动脉成形术 (PTCA)和支架术后心肌微损伤情况及其对近期预后的影响。方法 :选择 83例经造影证实为单支血管病变的稳定型心绞痛行PTCA和支架术后无严重并发症者。测定术前 ,术后 6、12、2 4及 4 8h血清cTnI、CK MB的水平 ,并随访观察术后 4～ 5周内心血管事件的发生情况 ,以及通过超声心动图检查术前和术后随访期间左室射血分数的变化。结果 :术后 2 3例出现cTnI或 (和 )CK MB阳性者 ,其中支架组 2 1例 ,球囊组 2例。cTnI阳性检出率 (2 4 .1% )明显高于CK MB阳性检出率 (6 .0 % ) (P <0 .0 1)。cTnI和 (或 )CK MB阳性 (损伤组 )术中球囊扩张的总时间、单次扩张最长时间以及分支血管阻塞的发生率均明显高于cTnI和 (或 )CK MB阴性 (未损伤组 ) (分别为P <0 .0 5、P <0 .0 1、P <0 .0 1) ,而球囊扩张次数和扩张的最大压力两组相比无明显差别 (P >0 .0 5 ) ,随访术后近期心血管事件的发生率和左室功能的变化两组无明显差异。结论 :PTCA及支架术后心肌微损伤并不少见 ,尤以支架术后发生率高。这种微损伤对近期预后的影响不大。检测这种微损伤的指标以cTnI明显优于CK MB。

Minor myocardial injury and it''s clinical effects after percutaneous transluminal coronary angioplasty with or without stenting

Objective:To investigate the minor myocardial injury and it's clinical effects after successful percutaneous transluminal coronary angioplasty(PTCA) with or without stenting. Methods:Eighty-three patients with stable angina and received uncomplicated PTCA or stenting to single vessel disease were selected. Serum levels of cardiac troponin I (cTnI) and CK-MB were measured before, 6, 12, 24 and 48 h after procedure. Echocardiogram were done to test LVEF during 4 to 5 weeks follow-up, and compared with the baseline before the procedure. All cardiac events were recorded during the follow-up periods.Results:Abnormal values of cTnI and(or) CK-MB were observed in 23 patients, 21 after stenting and 2 after PTCA alone. The frequency of abnormal cTnI levels was significantly higher than that of CK-MB after the procedure ( 24.1% vs 6.0%; P< 0.01). In injury group with abnormal cTnI and/or CK-MB, total time of inflation and maximum time of each inflation were longer than non-injury group of normal cTnI and/or CK-MB levels (P< 0.05 and P< 0.01), but there were no significant difference of times of inflation and maximum pressure between two groups(P> 0.05). The rate of side-branch occlusion was also higher in injury group ( 56.5% vs 18.3%; P< 0.01). Cardiac events occurred in 1 patient( 4.3%) of injury group compared with 4 patients ( 6.4%) of non-injury group (P> 0.05), and the changes of LVEF were almost same in two groups during follow-up.Conclusion:Minor myocardial injury is more common after stenting than PTCA alone. But there was no significant bad effect on the recent prognosis after this kind of injury.