介入治疗联合应用腺苷对不稳定型心绞痛患者冠状动脉血流和临床预后的影响

Effects of Adenosine on coronary artery patency and clinical outcomes in unstable angina patients underwent percutaneous coronary intervention

目的评价经皮冠状动脉介入治疗(PCI)联合静脉应用腺苷对不稳定型心绞痛(UA)患者冠状动脉血流和近期临床预后的影响。方法 2009年3～12月,60例准备行PCI的UA患者按随机数字表法分配到腺苷组(PCI术前10 min应用腺苷,30例)和对照组(PCI术前10 min应用生理盐水,30例)。观察两组在常规使用阿司匹林和氯吡格雷的基础上,PCI术前和术后即刻靶血管TIMI血流分级和校正的TIMI帧数(CTFC)。随访PCI术后3个月内两组患者主要不良心血管事件(MACE)的发生率。记录使用腺苷治疗期间不良反应的发生情况。结果两组PCI术前即刻靶血管TIMI血流2～3级发生率和CTFC差异无统计学意义(76.2%比72.5%,41.60±13.76比42.13±14.30,均为P>0.05)。两组PCI术后即刻靶血管TIMI血流3级发生率差异无统计学意义(97.6%比92.9%,P>0.05);腺苷组靶血管CTFC则显著优于对照组(23.03±8.38比28.50±10.24,P<0.05)。结论在阿司匹林、氯吡格雷抗血小板治疗的基础上,PCI联合静脉应用腺苷能改善UA患者术后靶血管冠状动脉血流。

Objective To evaluate the effects of Adenosine on target artery patency and clinical outcomes in unstable angina （UA） patients underwent pereutaneous coronary intervention （PCI）. Methods From March 2009 to December 2009, 60 UA patients underwent PCI were randomized to receive intravenous Adenosine （within 10 minutes before PCI, n=30） or saline （within 10 minutes before PCI, n = 30）. All subjects were pretreated with aspirin and clopidogrel. Thrombolysis In Myocardial Infarction （TIMI） flow grade and Corrected TIMI Frame Count （CTFC） of target artery before and after PCI were recorded. All the patients were followed up for 3 months and the incidence of major adverse cardiovascular event （MACE） after PCI were recorded. Results The TIMI flow grade 2-3 and CTFC were not statistically significant between the two groups before PCI （76. 2% vs. 72. 5% , 41.60 ±13.76 vs. 42. 13 ±14. 30, P 〉0. 05）. The TIMI flow grade 3 was similar between the two groups after PCI （97. 6% vs. 92.9% , P 〉0. 05）, but Adenosine group was associated with a significantly better CTFC （ 23.03 ±8.38 vs. 28.50± 10. 24, P 〈 0. 05 ）. Conclusions Based on pretreatment with Aspirin and Clopidogrel, Adenosine is associated with improved target artery patency.