cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2021-36-2-76-83cardiotomsk-1194Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESКомбинированный протокол дистантного ишемического кондиционирования как метод кардиопротекции у пациентов с острым инфарктом миокарда с подъемом сегмента STCombined protocol for remote ischemic conditioning as the method of cardioprotection in patients with acute ST-segment elevation myocardial infarctionhttps://orcid.org/0000-0001-9473-6833КореневаЕ. А.KorenevaE. A.

Коренева Евгения Александровна, младший научный сотрудник, лаборатория неотложной и интервенционной кардиологии

220036, Беларусь, Минск, ул. Р. Люксембург, 110Б

Eugenia A. Koreneva, Junior Research Scientist, Laboratory of Emergency and Interventional Cardiology

110B, R. Luxemburg str., Minsk, 220036, Belarus

nezapaminajka@mail.ruhttps://orcid.org/0000-0001-7817-0331ДенисевичТ. Л.DenisevichT. L.

Денисевич Татьяна Леонидовна, научный сотрудник, лаборатория хронической сердечной недостаточности

220036, Беларусь, Минск, ул. Р. Люксембург, 110Б

Tatiana L. Denisevich, Research Scientist, Laboratory of Chronic Heart Failure

110B, R. Luxemburg str., Minsk, 220036, Belarus

tatiana_leo@mail.ruhttps://orcid.org/0000-0002-2484-1723МрочекА. Г.MrochekA. G.

Мрочек Александр Геннадьевич, д-р мед. наук, профессор, академик Академии наук Республики Беларусь

220036, Беларусь, Минск, ул. Р. Люксембург, 110Б

Alexander G. Mrochek, Dr. Sci. (Med.), Professor, Full Member of the National Academy of Sciences of Belarus

110B, R. Luxemburg str., Minsk, 220036, Belarus

science@cardio.byhttps://orcid.org/0000-0002-4533-3728СтельмашокВ. И.StelmashokV. I.

Стельмашок Валерий Иванович, д-р мед. наук, доцент, заведующий лабораторией неотложной и интервенционной кардиологии

220036, Беларусь, Минск, ул. Р. Люксембург, 110Б

Valery I. Stelmashok, Dr. Sci. (Med.), Associate Professor, Chief of the Laboratory of Emergency and Interventional Cardiology

110B, R. Luxemburg str., Minsk, 220036, Belarus

stelval@yandex.byРеспубликанский научно-практический центр «Кардиология» Министерства здравоохранения Республики БеларусьБеларусьRepublican Scientific and Practical Centre “Cardiology”Belarus2021010720213627683Copyright © Коренева Е.А., Денисевич Т.Л., Мрочек А.Г., Стельмашок В.И., 20212021Коренева Е.А., Денисевич Т.Л., Мрочек А.Г., Стельмашок В.И.Koreneva E.A., Denisevich T.L., Mrochek A.G., Stelmashok V.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1194Введение

Введение. В настоящее время не существует общепринятой стратегии по ограничению реперфузионного повреждения (РП), наступающего после восстановления коронарного кровотока у пациентов с инфарктом миокарда (ИМ). В данной статье исследована эффективность одного из перспективных методов кардиопротекции.

Материал и методы

Материал и методы. Настоящее исследование являлось открытым проспективным рандомизированным контролируемым. Пациенты с диагнозом: ИМ с подъемом сегмента ST (ИМпST) передней стенки левого желудочка (ЛЖ) были распределены в контрольную группу (КГ, n = 44), где выполнялось стандартное первичное чрескожное коронарное вмешательство (пЧКВ), и основную группу (ОГ, n = 43), где на фоне пЧКВ проводилось дистантное ишемическое перкондиционирование (ДИперК) в комбинации с посткондиционированием (ДИпостК). Эффективность ДИК оценивалась по данным магнитно-резонансной томографии (МРТ) сердца.

Результаты

Результаты. Медианы объема зоны некроза (ЗН) миокарда ЛЖ были достоверно выше у пациентов КГ: 44,8 (33,6; 55,5) против 52,7 (35,5; 73,9) мл в ОГ, р = 0,039) на 10-е сут ИМ и через 6 мес. (34,0 (25,8; 39,8) мл и 46,0 (32,8; 55,0) мл соответственно, р = 0,004). Пациенты обеих групп не различались по показателю зоны рискованного миокарда (ЗР) относительно объема миокарда (ОМ) ЛЖ: 40 (35; 45)% и 43 (34; 49)% в ОГ и КГ соответственно, р = 0,232. Группы статистически значимо различались по показателю ЗН/ЗР: 70,3 (65,1; 86,6)% в КГ и 63,5 (52,7; 72,0)% в ОГ, р = 0,014, индексу спасенного миокарда (ИСМ): 29,7 (13,5; 34,9)% в КГ и 36,5 (28,0; 47,3)% в ОГ, р = 0,014. Выявлена тенденция к большей сохранности ОМ ЛЖ в ОГ по сравнению с КГ к 6-му мес. наблюдения (р = 0,073). Группы статистически значимо различались по медиане объема микроваскулярной обструкции (МВО): 1,9 (1,4; 2,9) мл в ОГ и 2,5 (1,8; 8,1) мл в КГ, p = 0,049 и доле МВО в ОМ ЛЖ: 0,94 (0,79; 1,37)% в ОГ; 1,50 (0,89; 3,66)% в КГ, р = 0,046.

Заключение

Заключение. Метод ДИК способствует ограничению размера инфаркта и МВО, а также связан с увеличением ИСМ у пациентов с ИМпST.

Background

Background. There is currently no commonly accepted strategy for limiting the reperfusion injury that occurs after revascularization in patients with myocardial infarction. This study aimed to investigate the efficacy of a promising cardioprotective method.

Material and Methods

Material and Methods. Patients with acute anterior ST-segment elevation myocardial infarction (STEMI) (n = 87) were included in an open-label prospective randomized controlled trial. Control group comprised patients with STEMI who underwent only primary percutaneous coronary intervention (PPCI) (n = 44). Patients of intervention group (n = 43) underwent PPCI and remote ischemic perconditioning combined with postconditioning (RIC). The efficacy of RIC was assessed based on cardiac magnetic resonance (CMR) imaging data.

Results

Results. The medians of left ventricular (LV) infarct size were significantly higher in patients of control group: 44.8 (33.6; 55.5) versus 52.7 (35.5; 73.9) mL (p = 0.039) at day 10 after STEMI and 34.0 (25.8; 39.8) mL versus 46.0 (32.8; 55.0) mL six months after STEMI in control and intervention groups, respectively (p = 0.004). The groups of patients did not differ in the sizes of area at risk relative to the total LV myocardial volume: 40 (35; 45) and 43 (34; 49)% in control and intervention groups, respectively (р = 0.232). The groups significantly differed in the ratios of infarct size to area at risk: 70.3 (65.1; 86.6)% in control group versus 63.5 (52.7; 72.0)% in intervention group (р = 0.014) as well as in the myocardial salvage indexes: 29.7 (13.5; 34.9)% in control group versus 36.5 (28.0; 47.3)% in intervention group (р = 0.014). The study showed the tendency to greater LV myocardial salvage in intervention group versus control group at six-months follow-up (р = 0.073). The groups significantly differed in the medians of microvascular obstruction volume: 1.9 (1.4; 2.9) mL in intervention group versus 2.5 (1.8; 8.1) mL in control group (p = 0.049) as well as in the proportions of microvascular obstruction in the LV myocardium: 0.94 (0.79; 1.37)% in intervention group versus 1.50 (0.89; 3.66)% in control group (р = 0.046).

Conclusion

Conclusion. The RIC method combined with PPCI contributed to the limitation of infarct and microvascular obstruction sizes and was associated with an increase in the myocardial salvage index in STEMI patients.

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The authors declare that there are no conflicts of interest present.