冠状动脉内注射腺苷与维拉帕米治疗急性冠状动脉综合征介入术中缓再流现象的对照研究

Effect and safety of intracoronary adenosine and verapamil on slow-reflow phenomenon following PCI in patients with acute coronary syndrome

目的对照观察冠状动脉内注射腺苷与维拉帕米对急性冠状动脉综合征(ACS)介入术中缓再流现象的疗效、副反应及对患者预后的影响。方法选取33例接受经皮冠状动脉腔内成形术和支架术(PTCA/STENT)后发生缓再流现象的急性冠状动脉综合征患者,随机分为腺苷组(17例)和维拉帕米组(16例)。腺苷组在发生缓再流现象的病变血管内注射腺苷3mg,维拉帕米组在病变血管内注射维拉帕米2.5mg。注射后1、5、10min后重复冠状动脉造影,记录注药前后病变血管内血流TI MI分级,并应用TI MI血流计帧法(TI MI frame count,TFC)定量测定血流速度,进行比较。详细记录用药前后患者血压、心率和心电图变化。结果注药前腺苷组和维拉帕米组TI MI血流分级分别为1.65±0.38和1.56±0.33,血流帧数分别为87.9±15.3和89.5±17.4,两组血流速度无明显差异(P>0.05)。腺苷组在冠脉内注药后有9例(53%)患者获得TI MI3级血流,注药后1、5、10min时血流帧数分别为58.5±13.4、45.8±9.7、50.2±11.6;维拉帕米组注药后有7例(44%)患者获得TI MI3级血流,注药后1、5、10min时血流帧数分别为68.9±15.6、59.7±14.5、62.3±16.2。两组冠状动脉内注药后血流均有明显改善(血流帧数与注药前比较P<0.05),腺苷组血流改善较维拉帕米组更为显著(P<0.05)。冠脉内注射2.5mg维拉帕米较注射3mg腺苷对患者血压和心率的影响更明显(P<0.05)。住院期间两组均无患者死亡,出院前心脏超声测LVEF在腺苷组为(46.5±10.2)%,维拉帕米组为(43.1±9.8)%,随访6个月,两组心血管事件(心绞痛、心肌梗死、心衰、心因性死亡)发生率分别为29.4%和43.8%,无统计学差异。结论腺苷与维拉帕米均能有效改善急性冠状动脉综合征介入术中缓再流现象。与维拉帕米相比较,腺苷能更安全、有效地改善冠状动脉血流。

Objective To contrast the effect and safety of intracoronary adenosine with verapamil on slow-reflow phenomenon following percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）. Methods 33 patients with ACS who developed slow-reflow phenomenon during PCI were divided into adenosine group （17 cases） and verapamil group （16 cases）. Patients in adenosine group were given 3 mg adenosine intracoronary through guiding catheter and patients in verapamil group were given 2.5 mg verapamil. 1 min, 5 rain and 10 min later coronary flow was assessed by the TIMI frame count method （TFC）. And the changes of electrocardiogram and blood pressure were written down. Resuits Before the administration of intracoronary drugs, the TFC in adenosine group and verapamil group was 87.9±15.3 and 89.5±17.4. After the drugs were given, the TFC in adenosine group decreased to 58.5±13.4, 45.8±9.7, 50.2±11.6 and in verapamil group to 68.9±15.6, 59.7±14.5, 62.3±16.2 at first, 5th, 10th rain respectively, TFC decreased greater in adenosine group than in verapamil group. Nine （53%） cases in adenosine group and 7 （44%） cases in verapamil group gained TIMI flow grade 3. Intracoronary administration of 2.5 mg verapamil can affect the heart rate and blood pressure more significantly than intracoronary administration of 3 mg adenosine. In hospital no death occur in both groups, during 6-month follow-up 29.4% （5 cases） patients in adenosine group and 43.8%0 （7 cases） in verapamil group developed major adverse cardiac events （MACE, including angina pectory, myocardia infarction, heart failure and death of heart disease）, there is no statistical difference between two groups. Conclusion Both adenosine and verapamil can improve the coronary artery blood flow velocity in patients with ACS who developed slow-reflow phenomenon during PCI; compared with verapamil,adenosine is more effective and safer.