冠状动脉内注射硫氮酮对急性心肌梗死直接经皮冠状动脉腔内成形术后缓再血流现象的作用

Effect of intracoronary administration of diltiazem on "slow-reflow" phenomenon following primary PTCA/Stent in Patients with AMI

目的 评价冠状动脉内应用硫氮酮 (diltiazem)对急性心肌梗死 (AMI)直接经皮冠状动脉腔内成形和支架术 (PTCA/Stent)后梗死相关动脉缓再血流 (slow reflow)现象的疗效及其安全性。方法 2 0例AMI直接PTCA/Stent后再通的梗死相关动脉 (infarct relatedartery ,IRA)存在slow reflow患者 ,男 13例 ,女 7例 ,年龄 (5 8 5± 9 5 )岁。其中闭塞血管右冠状动脉 10例 ,前降支 6例 ,回旋支 4例。从症状开始至PTCA/Stent开通IRA时间 (9 2± 2 1)h ,术后平均TIMI血流 (1 9± 0 4)级 ,先以硝酸甘油(nitroglycerin) 15 0 μg冠脉内注入 (确认slow reflow现象 )作为对照 ,10min后继以Diltiazem 5 0 0 μg(5 0 μg·ml-1·s-1)冠状动脉内注入 ,于给药后第 1、3、10min行冠状动脉造影 (CAG)。应用Gibson的TIMI血流计帧法和QCA测量系统分别行Nitroglycerin和Diltiazem冠状动脉内给药后不同时间点IRA再通后血流速率帧数和管腔直径的定量分析比较。结果 (1)术后基础对照与Nitroglycerin给药 3min时CAG血流帧数比较无明显变化 (89 8± 18 1)vs (88 9± 14 2 )帧 ,P >0 0 5 ;Diltiazem给药后第 1、3和 10min时CAG血流帧数分别较给药前减少 2 7 6 % ,32 6 %和 2 5 2 % (P均 <0 0 1) ,平均TIMI血流增加从(1 9± 0

Objective To assess the effect and safety of intracoronary administration of diltiazem on 'slow-reflow' phenomenon of infarct-related artery (IRA) following primary PTCA/STENT in patients with AMI. Methods Twenty patients [male 13, female 7, age (58.5±9.5) years] with AMI who had been successfully performed primary PTCA/STENT were found 'slow-reflow' phenomenon.Among the reopened IRAs (residual diameter stenosis <20%) 10 were in right coronary artery, 6 in left anteriol descendens and 4 in circumflux, in which the TIMI flow was 1.9±0.4 grade. PTCA/STENT was successfully performed about 9.2±2.1 hours after the onset of angina pectoris. Nitroglycerin (150μg) was 'bolus' injected into the IRA to exclude coronary artery spasm. Ten minutes later, diltiazem (500μg) was injected at a rate of 50μg·ml -1·s -1 and coronary angiography was performed at 1st, 3rd and 10th min after the injection. All data were analysized by Gibson′s TIMI frame count method and quantitative computer angiography (QCA) system. Results (1) No significant change was found at 3rd min after intracoronary administration of nitroglycerin (P>0.05); TIMI frames count was decreased by 22.6%, 32.6% and 25.2% at first, 3rd, 10th min, respectively, and average coronary blood flow was improved from TIMI grade (1.9±0.5) to (2.4±0.4) (P<0.05) after intracoronary administration of diltiazem.(2) The diameter of middle segment of reopened coronary artery was increased from (3.2±0.4) mm to (3.4±0.5) mm at 3rd min after intracoronary administration of dilitiazem (P>0.05), and lasting for 10 minutes. (3) During and after intracoronary administration of diltiazem, blood pressure, heart rate, P-R interval, QT interval and QRS duration were not found any significant changes (P>0.05). Conclusions Intracoronary administration of diltiazem 500μg (50μg·ml -1·s -1) proved to be safe and easy clinically might attenuate 'slow-reflow' phenomenon following primary PTCA/STENT in patients with AMI, and might be one of first choice in medical therapy for 'slow-reflow' phenomenon.