摘要
目的探讨早期应用伊伐布雷定控制心率对急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)后左心室重构的影响。方法纳入2017年7月至2019年7月期间在中国医学科学院阜外医院深圳医院心内科住院的STEMI成功行直接PCI且术后12 h为窦性心律、静息心率≥80次/分的患者,随机分为试验组和对照组,试验组患者在PCI术后12 h给予伊伐布雷定联合美托洛尔治疗,对照组仅给予美托洛尔口服,将出院时静息心率控制于<70次/分,随访90天。术前及术后定期测量心率及血压;行超声心动图检查测量左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、左心室舒张末期内径、左心室后壁厚度及室间隔厚度,计算左心室质量指数(LVMI);测定N末端B型利钠肽前体(NT‐proBNP)、高敏肌钙蛋白T(hsTnT)、高敏肌钙蛋白I(hsTnI)和超敏C反应蛋白(hsCRP)水平;记录住院期间及随访期间主要心血管不良事件(MACE)发生情况。结果共纳入66例患者,试验组32例,对照组34例。与对照组相比,试验组患者出院时、术后7 d、30 d、90 d心率下降,差异有统计学意义(P均<0.05),两组间血压差异无统计学差异(P均>0.05);试验组术后90 d时LVEDⅤ、LVESV及LVEF较对照组均有改善,差异有统计学意义(P均<0.05),两组患者LVMI差异无统计学意义(P>0.05)。术后90 d时NT‐proBNP水平较对照组降低,差异有统计学意义(P<0.05)。两组患者hsTnT、hsTnI及hsCRP水平差异无统计学意义(P均>0.05)。随访过程中对照组和试验组各有1例患者因再发心绞痛而入院,对照组有1例因心力衰竭再入院,试验组有1例出现心动过缓(心率<50次/分)。结论对于STEMI患者,直接PCI术后早期使用伊伐布雷定联合β受体阻滞剂控制心率可以改善左心室重构,保护心功能,且安全性和耐受性良好。
Objectives To investigate the effect of early control of heart rate(HR)with ivabradine on left ventricular remodeling in patients with acute ST segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods Patients admitted with STEMI from July 2017 to July 2019 in Shenzhen Hospital,Fuwai Hospital,Chinese Academy of Medical Sciences,with sinus rhythm and HR>80 bpm at 12 hours after successful primary PCI were randomly treated with ivabradine combined with metoprolol(ivabradine group)or metoprolol alone(control group).The resting HR at discharge was controlled<70 bpm.All patients were followed up for 90 days.HR,blood pressure(BP),N‐terminal pro‐brain natriuretic peptide(NT‐proBNP),high sensitivity troponin T and troponin I(hsTnT,hsTnI)and high sensitivity C reactive protein(hsCRP)were measured periodically.Echocardiography was performed at 1 d,7 d,30 d and 90 d after PCI to measure left ventricular end‐diastolic volume(LVEDV),left ventricular end‐systolic volume(LVESV),left ventricular ejection fraction(LVEF),left ventricular end‐diastolic diameter,left ventricular posterior wall thickness and inter‐ventricular septal thickness and left ventricular mass index(LVMI)was calculated.Major adverse cardiovascular events(MACE)were recorded.Results A total of 66 patients were enrolled and randomly divided to ivabradine group(n=32)and control group(n=34).HR was significantly lower in the ivabradine group than that in the control group at discharge and during follow‐up(7 d,30d and 90d after PCI)(all P<0.05).There was no difference in BP between these two groups(all P>0.05).LVEDV,LVESV and LVEF at 90d after PCI were significantly improved in the ivabradine group compared with the control group(all P<0.05)without significant difference in LVMI between these two groups(P>0.05).Level of NT‐proBNP was significantly lower in the ivabradine group than that in the control group at 90d(P<0.05).There were no significant differences in the levels of hsTnT,hsTnI and hsCRP between these two groups(all P>0.05).During follow‐up,one case in each group was readmitted due to recurrence of angina pectoris.Readmission due to heart failure occurred in one case in the control group,and bradycardia(HR<50 bpm)occurred in one case in the ivabradine group.Conclusions Early use of ivabradine combined with beta blocker to control HR in STEMI patients after successful primary PCI may alleviate left ventricular remodeling and improve heart function with satisfactory safety and tolerance.
作者
张文颖
徐验
钟新波
刘强
郭瑞瑞
闫少迪
陈海君
罗新林
郭文玉
王丽丽
何松坚
李华秋
Zhang Wenying;Xu Yan;Zhong Xinbo;Liu Qiang;Guo Ruirui;Yan Shaodi;Chen Haijun;Luo Xinlin;Guo Wenyu;Wang Lili;He Songjian;Li Huaqiu(Department of Pharmacy,Shenzhen Hospital,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen 518000,China;Department of Cardiology,Shenzhen Hospital,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen 518000,China;Department of Ultrasonography,Shenzhen Hospital,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen 518000,China)
基金
深圳市科技创新委员会科技计划资助项目(SZFZ2017045)
关键词
伊伐布雷定
急性心肌梗死
左心室重构
直接经皮冠状动脉介入治疗
Ivabradine
Acute myocardial infarction
Left ventricular remodeling
Primary percutaneous coronary intervention
