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首页> 外文期刊>Open Heart >Serial assessment of the index of microcirculatory resistance during primary percutaneous coronary intervention comparing manual aspiration catheter thrombectomy with balloon angioplasty (IMPACT study): a randomised controlled pilot study
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Serial assessment of the index of microcirculatory resistance during primary percutaneous coronary intervention comparing manual aspiration catheter thrombectomy with balloon angioplasty (IMPACT study): a randomised controlled pilot study

机译：串行经皮冠状动脉介入治疗期间微循环阻力指数的系列评估，比较手动抽吸导管血栓切除术与球囊血管成形术（IMPACT研究）：一项随机对照试验研究

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Objective Utilising a novel study design, we evaluated serial measurements of the index of microcirculatory resistance (IMR) in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) to assess the impact of device therapy on microvascular function, and determine what proportion of microvascular injury is related to the PPCI procedure, and what is an inevitable consequence of STEMI. Design 41 patients undergoing PPCI for STEMI were randomised to balloon angioplasty (BA, n=20) or manual thrombectomy (MT, n=21) prior to stenting. Serial IMR measurements, corrected for collaterals, were recorded at baseline and at each stage of the procedure. Microvascular obstruction (MVO) and infarct size at 24?h and 3?months were measured by troponin and cardiac MRI (CMR). Results IMR did not change significantly following PPCI, but patients with lower IMR values (32, n=30) at baseline had a significant increase in IMR following PPCI (baseline: 21.2±7.9 vs post-stent: 33.0±23.7, p=0.01) attributable to prestent IRA instrumentation (baseline: 21.7±8.0 vs post-BA or MT: 36.9±25.9, p=0.006). Post-stent IMR correlated with early MVO on CMR (p=0.01). There was no significant difference in post-stent IMR, presence of early MVO or final infarct size between patients with BA and patients treated with MT. Conclusions Patients with STEMI and less microcirculatory dysfunction may be susceptible to acute iatrogenic microcirculatory injury from prestent coronary devices. MT did not appear to be superior to BA in maintaining microcirculatory integrity when the guide wire partially restores IRA flow during PPCI. Trial registration number ISRCTN31767278.
机译：目的利用新颖的研究设计，我们评估了接受ST段抬高型心肌梗死（STEMI）的原发性经皮冠状动脉介入治疗（PPCI）患者的微循环阻力指数（IMR）的系列测量，以评估器械治疗对微血管功能的影响，并确定微血管损伤的比例与PPCI手术有关，以及STEMI的必然后果。设计41例行STPCI术的PPCI患者在支架置入术前被随机分为球囊血管成形术（BA，n = 20）或手动血栓切除术（MT，n = 21）。在基线和该过程的每个阶段都记录了校正了抵押品的串行IMR测量值。通过肌钙蛋白和心脏MRI（CMR）测量在24小时和3个月时的微血管阻塞（MVO）和梗塞面积。结果PPCI后IMR没有明显变化，但基线时IMR值较低（<32，n = 30）的患者在PPCI后IMR显着增加（基线：21.2±7.9 vs支架后：33.0±23.7，p = 0.01）归因于现今的IRA仪器（基线：21.7±8.0 vs BA后或MT：36.9±25.9，p = 0.006）。支架后IMR与CMR早期MVO相关（p = 0.01）。 BA患者和MT治疗患者的支架后IMR，早期MVO的存在或最终梗死面积无显着差异。结论STEMI且微循环功能障碍较少的患者可能会受到现成的冠状动脉装置引起的急性医源性微循环损伤。当在PPCI期间导丝部分恢复IRA流量时，MT在维持微循环完整性方面似乎不优于BA。试用注册号ISRCTN31767278。

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