The Protective Effect Of Gradually Prolonged Ischemic Postconditioning On Myocardial Reperfusion In Patients With STEMI

ObjectiveTo investigate the effect of gradually prolonged ischemic postconditioning(IPostC)modified reperfusion on myocardial ischemia-reperfusion injury(MIRI)during percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI).To Further explore the best post-ischemic adaptation mode,minimize reperfusion injury,and improve patient prognosis,with a view to applying it as a routine cardiac protective intervention in emergency PCI.MethodsThis study is a multi-center prospective randomized controlled trial.Seventy-two patients with STEMI who underwent PCI surgery in the University-Town Hospital of Chongqing Medical University,Xinqiao Hospital Affiliated to Army Military Medical University,and TongliangDistrict People 's Hospital of Chongqing were selected from May 2019 to January 2020.The study subjects were randomly divided into conventional IPostC group(control group)(n = 32)and the progressive IPostC group(experimental group)(n = 40).After the Infarct Related Artery(IRA)was opened in the conventional IPostC group,the pre-expanded balloon was used immediately upstream of the lesion for 4 cycles of low pressure(4-6atm,1atm = 101.325kPa)filling / withdrawal pressure for 30 s / 30 s,30s / 30 s,30s / 30 s,30s / 30 s,and then continue to reperfusion.In the progressive IPostC group,the post-adaptation operation was carried out by gradually extending the short perfusion time,that is,on the basis of the control group,the first 6 cycles of the post-adaptation operation were performed,and the specific time of balloon inflation / decompression was30 s / 5s,30 s / 5s,30 s / 10 s,30s / 10 s,30s / 15 s,30s / 20 s,and then 4 cycles of conventional post-adaptation operation.Compare the incidence of intraoperative reperfusion arrhythmia(RA),intraoperative stable vital signs and postoperative TIMI blood flow classification,preoperative and postoperative high-sensitivity cardiac troponin I(hs-cTn I),MB isoenzyme of creatine kinase(CK-MB),high-sensitivity C reactive protein(hs-CRP),N-terminal pro-brain natriuretic peptide(NT-proBNP),and left ventricular ejection fraction(LVEF)and other indicators.ResultsCompared with the conventional IPostC group,the progressive IPostCgroup has obvious advantages in postoperative hs-CRP,hs-cTn I,CK-MB,NT-proBNP,intraoperative RA incidence and stable vital signs,with statistically significant differences(P <0.05 or 0.01).There was no significant difference in TIMI and LVEF during hospitalization between the two groups of patients(P> 0.05).Conclusionsthe gradually prolonged IPostC modified reperfusion can reduce the incidence of RA during PCI in STEMI patients,stabilize the vital signs during operation,reduce inflammation,reduce the area of myocardial infarction,improve cardiac function,and have a significant protective effect on myocardial ischemia-reperfusion injury.