Background: In this study, we investigated whether adjunction of glucose- insulin- potassium(GIK) infusion to primary percutaneous coronary intervention(PCI) affects hemodynamics in patients with an acute myocardial i...Background: In this study, we investigated whether adjunction of glucose- insulin- potassium(GIK) infusion to primary percutaneous coronary intervention(PCI) affects hemodynamics in patients with an acute myocardial infarction. Methods: Hemodynamic measurements were performed in a subset of patients(n=81) in the GIPS 2, starting immediately after PCI and continued for 12 hours. Results: Cardiac index values were stable in both groups. During the first measurements, diastolic pulmonary artery pressure and the pulmonary capillary wedge pressure(PCWP) were significantly higher in the non- GIK group(diastolic pulmonary artery pressure 15± 5 vs 18± 7 mm Hg, P=.028 and PCWP 14± 6 vs 18± 7 mm Hg, P=.030). There was a decrease in PCWP from 18± 7 to 15± 6 mm Hg in the non- GIK group during the first 6 hours, whereas the pressures remained at 14± 6 mm Hg in the GIK group. This difference in pattern of change did not reach statistical significance in the analysis of the interaction of PCWP by GIK group(P=.065). Conclusions: Glucose- insulin- potassium infusion as adjunctive therapy to PCI in patients with acute myocardial infarction, without overt signs of heart failure, did not negatively affect hemodynamics.展开更多
文摘目的 :探讨右心导管肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)与心脏再同步化治疗(cardiac resynchronization therapy,CRT)慢性心衰疗效的相关性。方法:入选拟行心脏再同步化治疗的慢性心衰患者,术前1周内进行右心导管检查,测定肺毛细血管楔压;根据CRT术后患者心功能变化分成CRT有反应组与无反应组。术后6个月内左室射血分数(LVEF)提高超过5%,纽约心功能分级(NYHA)降低1级或1级以上者定义为CRT有反应;通过受试者工作曲线分析PCWP对CRT反应性的预测价值。应用Kaplan-Meier生存曲线分析不同水平PCWP患者主要心血管不良事件的差异。结果:35例CRT患者中有反应24例,无反应11例;有反应组PCWP(11.9±7.0)mm Hg,无反应组PCWP(21.7±9.1)mm Hg,两组间差异有统计学意义(P=0.006)。以PCWP 12.0 mm Hg为最佳分界点时,Youden指数最大,预测CRT反应性的敏感度为90.9%,特异度为58.3%。相对于PCWP>12.0 mm Hg组,PCWP≤12.0 mm Hg组CRT术后心功能、左室内径和PCWP更佳。Kaplan-Meier生存曲线表明PCWP≤12.0 mm Hg组患者比PCWP>12.0 mm Hg组患者无主要心血管不良事件的生存时间长,但未达到统计学差异(P=0.079)。结论:术前右心导管检测PCWP对CRT反应性有较好的预测价值。术前PCWP低的患者无主要心血管不良事件的生存时间长。
文摘Background: In this study, we investigated whether adjunction of glucose- insulin- potassium(GIK) infusion to primary percutaneous coronary intervention(PCI) affects hemodynamics in patients with an acute myocardial infarction. Methods: Hemodynamic measurements were performed in a subset of patients(n=81) in the GIPS 2, starting immediately after PCI and continued for 12 hours. Results: Cardiac index values were stable in both groups. During the first measurements, diastolic pulmonary artery pressure and the pulmonary capillary wedge pressure(PCWP) were significantly higher in the non- GIK group(diastolic pulmonary artery pressure 15± 5 vs 18± 7 mm Hg, P=.028 and PCWP 14± 6 vs 18± 7 mm Hg, P=.030). There was a decrease in PCWP from 18± 7 to 15± 6 mm Hg in the non- GIK group during the first 6 hours, whereas the pressures remained at 14± 6 mm Hg in the GIK group. This difference in pattern of change did not reach statistical significance in the analysis of the interaction of PCWP by GIK group(P=.065). Conclusions: Glucose- insulin- potassium infusion as adjunctive therapy to PCI in patients with acute myocardial infarction, without overt signs of heart failure, did not negatively affect hemodynamics.
