Circulation:再灌注治疗期间大剂量秋水仙碱是否可减小急性心肌梗死患者的梗死心肌面积?

2021-09-18 Nebula MedSci原创

在再灌注治疗期间,连续5天口服大剂量秋水仙碱并不能减小ST段抬高型心肌梗死患者的心肌梗死面积

炎症是ST段抬高型心肌梗死再灌注心肌损伤的关键因素。秋水仙碱是一种强效抗炎药。Mewton等研究人员推测,秋水仙碱或可减少ST段抬高型心肌梗死急性期的心肌梗死面积(IS)和左心室(LV)重构,并开展了一项随机双盲的多中心试验以进行验证,研究结果于近日发表在国际期刊《Circulation》上。

在该试验中,受试患者为拟进行经皮冠状动脉介入治疗的首次ST段心肌梗死的患者。从入院到第5天,受试患者随机接受秋水仙碱(首剂 2 mg,随后 0.5 mg*2次/天)或安慰剂口服。主要有效性终点是第5天时心脏磁共振评估的IS。次要终点是3个月时的相对LV舒张末期容积变化和IS(心脏磁共振评估)。

两组的心肌梗死面积

共招募了192位患者,其中101位被分至秋水仙碱组,91位被分至对照组。第5天时,秋水仙碱组和对照组之间钆增强定义的 IS 没有差异:平均LV质量为 26 vs 28.4 g(p=0.87)。随访3个月时,秋水仙碱组和对照组之间的LV重构也没有显著差异,左室舒张末期容积的变化分别是+2.4%(IQR -8.3%~11.1%)vs -1.1%(-8.0%~9.9%)(p=0.49)。3个月时,两组的心肌梗死面积也没有明显差异(左室质量:17 vs 18 g;p=0.92)。

主要终点的亚组分析

在治疗期间,秋水仙碱组的胃肠道不良反应事件的发生率高于对照组(34% vs 11%,p=0.0002)。

综上所述,在该随机、安慰剂为对照的试验中,在再灌注治疗期间,连续5天口服大剂量秋水仙碱并不能减小ST段抬高型心肌梗死患者的心肌梗死面积

原始出处:

Nathan Mewton, et al. Effect of Colchicine on Myocardial Injury in Acute Myocardial Infarction. Circulation. 2021;144:859–869. https://doi.org/10.1161/CIRCULATIONAHA.121.056177

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