西班牙一項研究表明,，遠(yuǎn)隔缺血后適應(yīng)（RIP）未能減輕擇期經(jīng)皮冠脈介入（PCI）相關(guān)性損傷,，并且接受RIP治療的糖尿病患者PCI相關(guān)性心肌梗死（PCI-MI）發(fā)生率更高。論文7月12日在線發(fā)表于《心臟》（Heart）,。
此項研究共納入232例因穩(wěn)定或不穩(wěn)定心絞痛而接受擇期PCI的患者,，并隨機(jī)給予RIP或安慰劑治療。主要轉(zhuǎn)歸指標(biāo)為24小時肌鈣蛋白I峰濃度,；次要轉(zhuǎn)歸指標(biāo)為住院治療,、因穩(wěn)定性心絞痛或急性冠脈綜合征行PCI以及隨訪1年后死亡率。對應(yīng)用RIP的糖尿病患者進(jìn)行特別研究,。
結(jié)果顯示,，受試者平均年齡為64.6歲，42%伴有糖尿病,。RIP和對照組患者的肌鈣蛋白峰值分別為0.476和0.478 ng/mL（P=0.99）,，PCI-MI發(fā)生率分別為36%和30.8%（P=0.378）。糖尿病RIP患者的PCI-MI發(fā)生率更高（OR 2.7,；P=0.027）,。RIP和安慰劑組的次要轉(zhuǎn)歸發(fā)生率分別為11.7%和10.8%（P=0.907）。（生物谷Bioon.com）
生物谷推薦英文摘要：
Heart doi:10.1136/heartjnl-2013-304172
Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial
Fernando Carrasco-Chinchilla, Antonio J Munoz-García, Antonio Domínguez-Franco, Gloria Millán-Vázquez, Alicia Guerrero-Molina, Carmen Ortiz-García, Alfredo Enguix-Armada, Juan H Alonso-Briales, Jose M Hernández-García, Eduardo de Teresa-Galván, Manuel F Jiménez-Navarro
Objective Determine whether remote ischaemic postconditioning (RIP) protects against percutaneous coronary intervention-related myocardial infarction (PCI-MI).
Design Single-centre, randomised, blinded to the researchers, clinical trial. ClinicalTrials.gov (NCT 01113008).
Setting Tertiary hospital centre.
Patients 232 patients underwent elective PCI for stable or unstable angina.
Interventions Patients were randomised to RIP (induction of three 5-min cycles of ischaemia in the arm after the PCI) versus placebo.
Main outcome measures The primary outcome measure was the peak 24-h troponin I level. PCI-MI was defined by an elevation of troponin values >3 or >5 of the 99th percentile according to the classical or the new definition. The secondary outcome measure was hospital admission, PCI for stable angina or acute coronary syndrome and mortality after 1?year of follow-up. The use of RIP in diabetic patients was specifically studied.
Results The mean age was 64.6years, and 42% were diabetic. The peak troponin in the RIP patients was 0.476 vs 0.478?ng/mL (p=0.99). PCI-MI occurred in 36% of the RIP patients versus 30.8% in the placebo group (p=0.378). Diabetic RIP patients had more PCI-MI (new definition): OR 2.7; 95% CI 1.10 to 6.92; p=0.027. The secondary outcome measure was seen in 11.7% of the RIP patients versus 10.8% in the placebo group (p=0.907).
Conclusions RIP did not reduce the damage associated with elective PCI or cardiovascular events during the follow-up. The diabetic population who underwent RIP had more PCI-MI.
