| Objective: Patients with acute ST segment elevation myocardial infarction who received emergency percutaneous coronary intervention were treated with local ischemic postconditioning before myocardial reperfusion.To understand the changes of serum soluble factor related apoptosis and soluble factor related apoptosis ligand and the incidence of major cardiovascular adverse events within one year,and to explore the changes of prognosis and its possible mechanism.Methods: A total of 90 patients who were diagnosed as STEMI in the emergency department of Changsha Central Hospital affiliated to University of South China since May 1,2018 were randomly divided into three groups: routine group(n=30),IPOC45 s group(n=30)and IPOC60 s group(n=30)according to whether or not ischemic postconditioning was intervened and the time limit of intervention.In the routine group,PCI was performed directly;in the IPOC45 s group,the guide wire was changed through the culprit vascular disease,and within 1 minute after the blood flow was restored,the pre-dilated balloon was placed upstream of the culprit vascular lesion and inflated by low pressure(4-6 standard atmospheric pressure)45s/ for 45 seconds,repeated for 3 cycles;IPOC60s group,the operation method was the same as the IPOC45 s group,but the duration of each inflation or outgassing was 60 s.The age,sex,weight,smoking history,past history and preoperative biochemical indexes of all patients were collected.as well as clinical data such as chest pain time,Door to balloon,criminal blood vessels and so on.The concentration of serum creatine phosphokinase isoenzyme was observed and the area under the curve was calculated from 0h before operation to 72 h after operation.The decline of ST segment of ECG at 1 hour after operation,the changes of left ventricular ejection fraction by echocardiography at 1 month,3 months,6 months and 1 year after operation,and the changes of 48 h serum soluble factor related apoptosis and soluble factor related apoptosis ligand concentrations before operation,0h,24 h and 24 h after operation were observed.The patients were followed up for 1 year to observe the occurrence of MACE events(including cardiogenic death,recurrent angina pectoris caused by ischemic cardiomyopathy,non-fatal recurrent acute myocardial infarction,stroke,repeated hospitalization of non-fatal heart failure,non-fatal arrhythmia,etc.)Results: 1.There was no significant difference among the three groups in age,sex,BMI,history of hypertension,history of diabetes,family history of coronary heart disease,history of smoking,preoperative blood lipids,blood glucose,CRP,cTnI,BNP,CK-MB,chest pain time,gateball time,coronary angiography related data and postoperative medication(all P>0.05).2.Comparison of serum sFas concentration among the three groups: there was no significant difference in serum sFas concentration among the three groups before operation,0h and 24 h after operation(all P>0.05).48 hours after operation,compared with the routine group,the serum sFas concentration in the IPOC60 s group and the IPOC45 s group decreased significantly[(20.50±12.68)ng/ml?(35.00±19.78)ng/ml vs(57.35±30.87)ng/ml,all P<0.05],and the serum sFas concentration in the IPOC60 s group was significantly lower than that in the IPOC45 s group(P<0.05).3.Comparison of serum sFasl concentration among the three groups: there was no significant difference in serum sFasl concentration among the three groups before operation,0h and 24 h after operation(all P>0.05).48 hours after operation,compared with the routine group,the serum sFasl concentration in the IPOC60 s group and the IPOC45 s group decreased significantly[(22.91±14.77)ng/ml?(40.66±30.82)ng/ml vs(63.21±34.70)ng/ml,all P<0.05],and the serum sFasl concentration in the IPOC60 s group was significantly lower than that in the IPOC45 s group(P<0.05).4.Comparison of the area under the CKMB curve among the three groups: compared with routine group,the area under serum CKM B curve in IPOC60 s group and IPOC45 s group decreased significantly[(4548.68±2182.85)?(5410.92±2514.06)vs(7090.57±3770.46)],and the difference was statistically significant(all P<0.05),but there was no s ignificant difference between IPOC60 s group and IPOC45 s group(P>0.05).5.Comparison of the decline of ST segment at 1 hour after operation among the three groups: compared with the routine group,the decrease of ST segment at 1 hour after operation in IPOC60 s group and IPOC45 s group was significantly increased(23?22vs13),and the difference was statistically significant(all P<0.05),but there was no significant difference between IPOC60 s group and IPOC45 s group(P>0.05).6.There was no significant difference in LVEF values among the three groups at 1 week,1 month and 3 months after operation(all P>0.05),but at 6 months after operation,the values of LVEF in IPOC60 s group and IPOC45 s group were higher than those in routine group[(63.85±6.75)?(59.28±8.27)vs(54.67±9.76),? P<0.05],and the LVEF value in patients with IPOC60 s was higher than that in IPOC45 s group(P<0.05).One year after operation,the value of LVEF in IPOC60 s group and IPOC45 s group was higher than that in routine group[(66.00±6.81)?(60.41±10.85)vs(56.07±10.97),all P<0.05],but there was no significant difference between IPOC45 s group and IPOC60 s group(P>0.05).7.During the follow-up for 1 year,compared with the routine group,the proportion of patients with non-fatal heart failure in IPOC60 s group and IPOC45 s group was significantly lower than that in routine group(2?4vs11,all P<0.05).The proportion of patients with angina pectoris in IPOC60 s group was significantly lower than that in IPOC45 s group and routine group(2vs 8?13,all P<0.05),but there was no significant difference in the proportion of patients with fatal arrhythmia,recurrent myocardial infarction and stroke among the three groups(all P>0.05).During the follow-up period,there was no death caused by heart failure,recurrent myocardial infarction,malignant arrhythmia and so on.Conclusion:1.Myocardial reperfusion therapy after local ischemic postconditioning can significantly improve the prognosis of patients with STEMI within one year;it is mainly manifested in the significant decrease in the incidence of non-fatal heart failure and angina pectoris.2.The mechanism of the effect may be related to the fact that local ischemic postconditioning can inhibit myocardial cell apoptosis induced by myocardial reperfusion,thus reduce myocardial injury and improve cardiac function.3.The intervention time limit of 60 seconds may be more significant than that of 45 seconds. |
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