全程远隔缺血适应对急性前壁心肌梗死患者心功能及预后的影响(CORIC-MI研究的结果)  

Effect of comprehensive remote ischemic conditioning on cardiac function and prognosis in patients with acute anterior myocardial infarction:the randomized CORIC-MI trial

作　　者：周鹏[1] 刘臣[1] 李健楠[1] 周金英[1] 陈润真 赵宵潇 王莹 赵汉军[1] 宋莉[1] 颜红兵 ZHOU Peng;LIU Chen;LI Jian-nan;ZHOU Jin-ying;CHEN Run-zhen;ZHAO Xiao-xiao;WANG Ying;ZHAO Han-jun;SONG Li;YAN Hong-bing(Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]国家心血管病中心、北京协和医学院、中国医学科学院阜外医院冠心病中心,北京100037 [2]中国医学科学院阜外医院深圳医院冠心病中心

出　　处：《中国介入心脏病学杂志》2022年第12期881-889,共9页Chinese Journal of Interventional Cardiology

基　　金：中国医学科学院医学与健康科技创新工程基金(2016-I2M-1-009、NCT 03593928);三名工程(深圳市第5批引进高层次医学团队)中国医学科学院阜外医院颜红兵急性冠状动脉综合征诊治团队。

摘　　要：目的探索急性前壁心肌梗死患者应用全程远隔缺血适应治疗后(缺血间期及缺血后28 d)对心功能及临床预后的影响。方法本研究采用单中心、前瞻性、非盲、随机、对照入组,从2017年4月至2019年9月连续入选中国医学科学院阜外医院因急性前壁ST段抬高型心肌梗死行直接经皮冠状动脉介入治疗的患者共163例,按照1:1比例随机分入对照组和全程远隔缺血适应组,全程远隔缺血适应组患者从血管再灌注前(缺血间适应)、血管再灌注后即刻(缺血后适应)直至介入治疗术后第28天(延迟缺血后适应)通过袖带加压充放气的方式完成全程远隔缺血适应治疗。所有患者临床随访12个月。共有126例患者术后30 d时完成心脏磁共振成像。结果对照组的心肌肌钙蛋白I峰值高于全程远隔缺血适应组[30.672(14.472,57.111)ng/ml比22.771(7.908,40.027)ng/ml,P=0.008];而30d时超声心动图测得的左心室射血分数低于全程远隔缺血适应组[(56.3±7.7)%比(59.1±7.5)%,P=0.027]。全程远隔缺血适应组与对照组相比,没有增加30 d时心脏磁共振成像测得的左心室射血分数[(49.8±10.0)%比(48.4±10.2)%,P=0.419];两组延迟强化的体积分数差异无统计学意义[11.5(2.9,17.3)%比10.8(5.8,19.8)%,P=0.585];两组随访12个月时的主要不良心脑血管事件发生率差异无统计学意义(8.5%比2.5%,P=0.096)。结论全程远隔缺血适应组并没有增加急性前壁心肌梗死患者30 d时心脏磁共振成像测得的左心室射血分数,没有改善12个月时的临床事件发生率。Objective This study was conducted to investigate the effect of remote ischemic conditioning on cardiac function and clinical prognosis in patients with acute anterior myocardial infarction(peri-conditioning and post-conditioning 28 days after ischemic event).Methods This was a single-center,prospective,open-labeled,randomized controlled trial.A total of 163 patients with acute anterior ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were consecutively enrolled in Fuwai hospital from April 2017 to September 2019,according to 1:1 ratio randomly assigned into control group and comprehensive remote ischemic conditioning group.Patients in the comprehensive remote ischemic conditioning group received intermittent ischemia and reperfusion applied to the thigh through five cycles of 5-min inflation and 5-min deflation of an automated cuff device before reperfusion(per-conditioning),repeated five cycles immediately after reperfusion(post-conditioning),and repeated five cycles every day until28 days(delayed post-conditioning).All patients were followed up for 12 months.A total of126 patients underwent cardiac magnetic resonance at 30 days.Results The peak value of cardiac troponin in the control group was higher than that in the comprehensive remote ischemic conditioning group[30.672(14.472,57.111)ng/ml vs.22.771(7.908,40.027)ng/ml,P=0.008].Left ventricular ejection fraction measured by echocardiography at 1 month in the control group was lower than that in the comprehensive remote ischemic conditioning group[(56.3±7.7)%vs.(59.1±7.5)%,P=0.027].There was no difference of the left ventricular ejection fraction measured by cardiac magnetic resonance at 30 days between the comprehensive remote ischemic conditioning group and the control group[(49.8±10.0)%vs.(48.4±10.2)%,P=0.419].There was no statistically significant difference in the volume fraction of delayed enhancement between the two groups[11.5(2.9,17.3)%vs.10.8(5.8,19.8)%,P=0.585].There was no significant difference

关 键 词：远隔缺血适应 急性前壁心肌梗死 经皮冠状动脉介入治疗 心脏磁共振成像 

分 类 号：R541[医药卫生—心血管疾病]