Tom 12, Nr 4 (2017)
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Opublikowany online: 2017-09-20

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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Inwazyjna ocena mikrokrążenia wieńcowego u pacjentów z zawałem serca z uniesieniem odcinka ST

Natalia Pietraszek1, Olga Możeńska2, Jacek Bil1
Kardiol Inwazyjna 2017;12(4):18-24.

Streszczenie

Pierwotna przezskórna interwencja wieńcowa (pPCI) jest złotym standardem w leczeniu pacjentów zgłaszających się z ostrym zespołem wieńcowym z uniesieniem odcinka ST. Mimo to, śmiertelność wśród pacjentów w trakcie pierwszego roku po przeprowadzeniu zabiegu nadal pozostaje znaczna. Częściowo dzieje się tak ze względu na współistnienie lub późniejsze wystąpienie urazu reperfuzyjnego, wśród którego można wyróżnić niedrożność naczyń mikrokrążenia (MVO). Obecnie istnieją różnymi nieinwazyjne metody oceny mikrokrążenia, jednak wykrycie jakichkolwiek zaburzeń nawet już po kilku godzinach od przeprowadzenia pPCI może okazać się już zbyt późnym działaniem. Dlatego też ważne jest, aby diagnostyki nie opóźniać i jak najwcześniej wykryć zator w mikrokrążeniu, najlepiej jeszcze w trakcie pPCI, wdrażając postępowanie interwencyjne, tak aby pacjent mógł odnieść jak największy efekt terapii.

Referencje

  1. Bulluck H, Foin N, Tan JW, et al. Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment-Elevation Myocardial Infarction Patients: Where Do We Stand? Circ Cardiovasc Interv. 2017; 10(3).
  2. Hausenloy DJ, Yellon DM. Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J Clin Invest. 2013; 123(1): 92–100.
  3. Yellon DM, Hausenloy DJ. Myocardial reperfusion injury. N Engl J Med. 2007; 357(11): 1121–1135.
  4. Abbas A, Matthews GH, Brown IW, et al. Cardiac MR assessment of microvascular obstruction. Br J Radiol. 2015; 88(1047): 20140470.
  5. Knaapen P, Camici PG, Marques KM, et al. Coronary microvascular resistance: methods for its quantification in humans. Basic Res Cardiol. 2009; 104(5): 485–498.
  6. De Bruyne B, Pijls NH, Smith L, et al. Coronary thermodilution to assess flow reserve: experimental validation . Circulation. 2001; 104(17): 2003–2006.
  7. Carrick D, Haig C, Carberry J, et al. Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction. JCI Insight. 2016; 1(6): e85768.
  8. Furber AP, Prunier F, Nguyen HC, et al. Coronary blood flow assessment after successful angioplasty for acute myocardial infarction predicts the risk of long-term cardiac events. Circulation. 2004; 110(23): 3527–3533.
  9. Martínez GJ, Yong ASC, Fearon WF, et al. The index of microcirculatory resistance in the physiologic assessment of the coronary microcirculation. Coron Artery Dis. 2015; 26 Suppl 1: e15–e26.
  10. Jin X, Yoon MH, Seo KW, et al. Usefulness of Hyperemic Microvascular Resistance Index as a Predictor of Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. Korean Circ J. 2015; 45(3): 194–201.
  11. Niccoli G, Scalone G, Lerman A, et al. Coronary microvascular obstruction in acute myocardial infarction. Eur Heart J. 2016; 37(13): 1024–1033.
  12. McGeoch R, Watkins S, Berry C, et al. The index of microcirculatory resistance measured acutely predicts the extent and severity of myocardial infarction in patients with ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2010; 3(7): 715–722.
  13. Baek YS, Park SD, Kim SH, et al. Clinical and Angiographic Predictors of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction. Yonsei Med J. 2015; 56(5): 1235–1243.
  14. Patel N, Petraco R, Dall'Armellina E, et al. Zero-Flow Pressure Measured Immediately After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Provides the Best Invasive Index for Predicting the Extent of Myocardial Infarction at 6 Months: An OxAMI Study (Oxford Acute Myocardial Infarction). JACC Cardiovasc Interv. 2015; 8(11): 1410–1421.
  15. Ahn SG, Hung OY, Lee JW, et al. Combination of the Thermodilution-Derived Index of Microcirculatory Resistance and Coronary Flow Reserve Is Highly Predictive of Microvascular Obstruction on Cardiac Magnetic Resonance Imaging After ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv. 2016; 9(8): 793–801.
  16. Ito N, Nanto S, Doi Y, et al. Beneficial effects of intracoronary nicorandil on microvascular dysfunction after primary percutaneous coronary intervention: demonstration of its superiority to nitroglycerin in a cross-over study. Cardiovasc Drugs Ther. 2013; 27(4): 279–287.
  17. Kobayashi Y, Fearon W. Invasive Coronary Microcirculation Assessment. Circulation Journal. 2014; 78(5): 1021–1028.
  18. Kitabata H, Kubo T, Ishibashi K, et al. Prognostic value of microvascular resistance index immediately after primary percutaneous coronary intervention on left ventricular remodeling in patients with reperfused anterior acute ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2013; 6(10): 1046–1054.
  19. Schröder R. Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction. Circulation. 2004; 110(21): e506–e510.
  20. Giugliano RP, Sabatine MS, Gibson CM, et al. Combined assessment of thrombolysis in myocardial infarction flow grade, myocardial perfusion grade, and ST-segment resolution to evaluate epicardial and myocardial reperfusion. Am J Cardiol. 2004; 93(11): 1362–7, A5.
  21. Kaul S. Myocardial contrast echocardiography: a 25-year retrospective. Circulation. 2008; 118(3): 291–308.
  22. Carrick D, Haig C, Ahmed N, et al. Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance. Circ Cardiovasc Imaging. 2016; 9(1): e004148.
  23. Ogasawara S, Mukawa H, Sone T, et al. Presence of myocardial hypoenhancement on multidetector computed tomography after primary percutaneous coronary intervention in acute myocardial infarction predicts poor prognosis. Int J Cardiol. 2015; 184: 101–107.
  24. Watabe H, Sato A, Nishina H, et al. Enhancement patterns detected by multidetector computed tomography are associated with microvascular obstruction and left ventricular remodelling in patients with acute myocardial infarction. Eur Heart J. 2016; 37(8): 684–692.
  25. Hof Av, Liem A, Suryapranata H, et al. Angiographic Assessment of Myocardial Reperfusion in Patients Treated With Primary Angioplasty for Acute Myocardial Infarction : Myocardial Blush Grade. Circulation. 1998; 97(23): 2302–2306.
  26. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93(5): 879–888.
  27. Henriques JPS, Zijlstra F, van 't Hof AWJ, et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation. 2003; 107(16): 2115–2119.
  28. Gibson CM, Cannon CP, Murphy SA, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation. 2000; 101(2): 125–130.
  29. Kaul S. Coronary angiography cannot be used to assess myocardial perfusion in patients undergoing reperfusion for acute myocardial infarction. Heart. 2001; 86(5): 483–484.
  30. Fearon WF, Balsam LB, Farouque HM, et al. Novel index for invasively assessing the coronary microcirculation. Circulation. 2003; 107(25): 3129–3132.
  31. Pijls NHJ, De Bruyne B, Smith L, et al. Coronary thermodilution to assess flow reserve: validation in humans. Circulation. 2002; 105(21): 2482–2486.
  32. Berry C, Corcoran D, Hennigan B, et al. Fractional flow reserve-guided management in stable coronary disease and acute myocardial infarction: recent developments. Eur Heart J. 2015; 36(45): 3155–3164.
  33. Ng MKC, Yeung AC, Fearon WF. Invasive assessment of the coronary microcirculation: superior reproducibility and less hemodynamic dependence of index of microcirculatory resistance compared with coronary flow reserve. Circulation. 2006; 113(17): 2054–2061.
  34. Aarnoudse W, Fearon WF, Manoharan G, et al. Epicardial stenosis severity does not affect minimal microcirculatory resistance. Circulation. 2004; 110(15): 2137–2142.
  35. Layland J, MacIsaac AI, Burns AT, et al. When collateral supply is accounted for epicardial stenosis does not increase microvascular resistance. Circ Cardiovasc Interv. 2012; 5(1): 97–102.