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远程缺血预处理对急性心肌梗死患者的影响
作者:小柯机器人 发布时间:2019/9/8 9:11:43

英国伦敦学院大学Hans Erik Bøtker、Derek J Hausenloy研究团队,进行了远程缺血预处理对急性心肌梗死患者临床结局的影响:一项单盲随机对照试验。相关论文2019年9月6日在线发表在《柳叶刀》上。

对于初次经皮冠状动脉介入治疗(PPCI)的ST段抬高型心肌梗死(STEMI)患者,臂部使用短暂缺血再灌注的远程缺血预处理可减少心肌梗死面积。

这项由国际调查员发起的、前瞻性、单盲、随机对照试验(CONDI-2/ERIC-PPCI)在英国、丹麦、西班牙和塞尔维亚的33个中心进行。2013年11月6日至2018年3月31日,共招募了5401例患者,年龄>18岁,疑似STEMI,且耐受PPCI,按1:1随机分组,2701例在PPCI前接受标准治疗,2700例接受远端缺血预处理,通过血压计自动袖带进行4个周期的5分钟充气和5分钟放气来对手臂进行间歇性缺血和再灌注。

排除入院或失访患者后,最终对照组2569例,干预组2546例患者纳入意向治疗分析。PPCI术后12个月,远程缺血预处理组中有239例(9.4%)患者发生心源性死亡或因心力衰竭而住院,对照组中有220例(8.6%),风险比为1.10。远程缺血预处理组中未发生重大意外不良事件或副作用。

对于接受PPCI的STEMI患者,远程缺血预处理并不能改善12个月时的临床结局(心源性死亡或因心力衰竭而住院)。

附:英文原文

Title: Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial

Author: Derek J Hausenloy, Rajesh K Kharbanda, Ulla Kristine Mller, Manish Ramlall, Jens Aare, Robert Butler, Heerajnarain Bulluck, Tim Clayton, Ali Dana, Matthew Dodd, Thomas Engstrom, Richard Evans, Jens Flensted Lassen, Erika Frischknecht Christensen, José Manuel Garcia-Ruiz, Diana A Gorog, Jakob Hjort, Richard F Houghton, Borja Ibanez, Rosemary Knight, Freddy K Lippert, Jacob T Lnborg, Michael Maeng, Dejan Milasinovic, Ranjit More, Jennifer M Nicholas, Lisette Okkels Jensen, Alexander Perkins, Nebojsa Radovanovic, Roby D Rakhit, Jan Ravkilde, Alisdair D Ryding, Michael R Schmidt, Ingunn Skogstad Riddervold, Henrik Toft Srensen, Goran Stankovic, Madhusudhan Varma, Ian Webb, Christian Juhl Terkelsen, John P Greenwood, Derek M Yellon, Hans Erik Bøtker,

Issue&Volume: September 06, 2019

Abstract:

Background

Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months.

Methods

We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed.

Findings

Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91–1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed.

Interpretation

Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI.

DOI: 10.1016/S0140-6736(19)32039-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32039-2/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet