Mechanism of PTCRA-induced injury of the coronary microcircuration

PTCRA引起冠状动脉微循环损伤的机制

基本信息

批准号：
11670722
负责人：
MATSUMOTO Takahiro
金额：
$ 1.98万
依托单位：
KURUME UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1999
资助国家：
日本
起止时间：
1999 至 2000
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-11670722/
关键词：
PTCRA Coronary microcirculation ADENOSINE PIATELET

项目摘要

Prolonged chest pain and bradycardia are well known complications during percutaneous transiuminal coronary rotational atherectomy (PTCRA), which limit its usefulness. Adenosine has been implicated in myocardial ischemia-related bradycardia and the perception of anginal pain. However, it is not known whether adenosine is also responsible for chest pain and bradycardia during PTCRA.We assessed the inhibitory effect of aminophylline, an adenosine P1 receptor antagonist, on PTCRA-related prolonged chest pain and bradycardia. Of 20 patients with effort angina who underwent PTCRA, aminophylline (5mg/kg) was administered intravenously before the procedure in 10 patients (group A) or saline in the other 10 patients (group B). Patient characteristics (age, sex, coronary risk factors, presence of previous myocardial Infarction and medications) and the lesion location and morphology were similar between these two groups. PTCRA was successful in all patients and there was no significant difference in the procedure (burr/artery ratio, speed and duration of the ablation) between these two groups. In group A, none of 10 patients had chest pain or bradycardia during PTCRA.However , 5 and 4 of 10 patients in group B had chest pain and profound bradycardia (<50bpm) (p<0.05). The changes of blood pressure and ΣST-elevation (sum of ST segment elevations) on the electrocardiograms during PTCRA were similar between these two groups. Plasma levels of P-selectin in the distal coronary artery were increased after PTCRA in both two groups. In conclusion, aminophylline did not reduce the severity of myocardial ischemia during PTCRA, probably due, in part, to the platelet activation, but indeed reduced PTCRA-related chest pain and bradycardia probably by antagonizing the adenosine P1 receptor. The pretreatment with aminophylline may make PTCRA safer and easier.

长时间的胸痛和心动过缓是经皮冠状动脉旋切术 (PTCRA) 期间众所周知的并发症，这限制了腺苷的用途，与心肌缺血相关的心动过缓和心绞痛的感觉有关，但尚不清楚腺苷是否与此有关。也导致 PTCRA 期间的胸痛和心动过缓。我们评估了氨茶碱（一种腺苷 P1 受体）的抑制作用在 20 名接受 PTCRA 的劳力性心绞痛患者中，10 名患者（A 组）术前静脉注射氨茶碱（5mg/kg），其他 10 名患者（组）注射生理盐水。 B). 两组患者的特征（年龄、性别、冠状动脉危险因素、既往心肌梗死情况和药物治疗）以及病变位置和形态相似，PTCRA 是成功的。 A 组中，10 名患者在 PTCRA 期间均未出现胸痛或心动过缓。然而，5 名和 4 名患者在手术过程（毛刺/动脉比率、消融速度和持续时间）方面没有显着差异。 B 组中有 10 名患者出现胸痛和严重心动过缓 (<50bpm) (p<0.05) 血压和 ΣST 抬高（ST 段抬高之和）的变化。两组 PTCRA 期间心电图相似两组 PTCRA 后远端冠状动脉血浆 P-选择素水平均升高。总之，氨茶碱并未减轻 PTCRA 期间心肌缺血的严重程度，这可能是由于：部分原因是血小板活化，但确实可能通过拮抗腺苷 P1 受体来减轻 PTCRA 相关的胸痛和心动过缓。氨茶碱可能使 PTCRA 更安全、更容易。