Myocardial Reperfusion Injury, Prognosis, ST Elevation Myocardial Infarction, Treatment Outcome
Conditions
Keywords
extracorporeal cardiac shock waves, Endothelial progenitor cell, miR-140-3p
Brief summary
This trial was a prospective, open-label, single-center, randomized trial, To observe the clinical efficacy of extracorporeal cardiac shock wave in the treatment of patients with myocardial ischemia-reperfusion injury and the difference in the level of endothelial progenitor cell-derived miR-140-3p in patients with myocardial ischemia-reperfusion injury treated with extracorporeal cardiac shock wave and control group and its relationship with clinical efficacy and prognosis. In order to provide a new therapy for patients with myocardial ischemia-reperfusion injury.
Detailed description
This trial was a prospective, open-label, single-center, randomized trial, To observe the clinical efficacy of extracorporeal cardiac shock wave in the treatment of patients with myocardial ischemia-reperfusion injury and the difference in the level of endothelial progenitor cell-derived miR-140-3p in patients with myocardial ischemia-reperfusion injury treated with extracorporeal cardiac shock wave and control group and its relationship with clinical efficacy and prognosis. In order to provide a new therapy for patients with myocardial ischemia-reperfusion injury.Patients with acute ST-segment elevation myocardial infarction who underwent coronary artery stenting (PCI) were randomly divided into extracorporeal cardiac shock wave treatment group and blank control group. The primary endpoint was to analyze the clinical symptoms, cardiac structure and function, coronary microcirculation, readmission rate, related score and prognosis between the two groups. The secondary end point was to draw the survival curve of the two groups according to the follow-up situation, and establish a Cox regression model to analyze whether the survival prognosis of patients was correlated with the expression level of miR-140-3p.
Interventions
DEVICEExtracorporeal cardiac shock wave therapy(ECSW)
Extracorporeal cardiac shock wave therapy (CSWT) is a cutting-edge technology developed in the world for more than 20 years. It is mainly used in the treatment of refractory angina pectoris of coronary heart disease. The mechanism of extracorporeal cardiac shock wave therapy is mainly due to the small attenuation, small shear stress and strong penetration force of shock wave when propagating in human tissues. Shear stress and hole effect are generated in the focal area of shock wave, which leads to the repeated formation/rupture of microbubbles in tissue/cell microenvironment, resulting in various physical and biological effects. These physical mechanisms trigger a series of biological effects, such as promoting the expression of various intracellular cytokines and angiogenic factors, activating related signal transduction pathways, inhibiting apoptosis and oxidative stress, and finally increasing the number of new blood vessels in the treatment area and improving the ischemic state.
Sponsors
First Affiliated Hospital of Kunming Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Patients with acute ST-segment elevation myocardial infarction undergoing Percutaneous coronary intervention (PCI) were randomly divided into extracorporeal cardiac shock wave treatment group and blank control group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Age ≥18 years The patient was diagnosed with acute ST-segment elevation myocardial infarction for the first time, and coronary angiography showed moderate to severe coronary artery stenosis. PCI was performed within 12 hours of the onset of the disease according to the current guidelines, and postoperative hemodynamic stability was achieved CCS angina pectoris grade Ⅱ or above, NYHA cardiac function grade I-Ⅲ Imaging examination \[stress echocardiography and/or stress myocardial perfusion imaging\] suggested objective evidence of reversible myocardial ischemia Voluntary participation, able to cooperate with treatment and follow-up, signed informed consent.
Exclusion criteria
severe unprotected left main stem lesions Left ventricular systolic function was impaired with hemodynamic instability chronic obstructive pulmonary disease, pulmonary maculopathy, post-pseudobulbar placement or other causes of poor sonographic window Combined with chest malignant tumor pregnancy The skin of the treatment area is broken or infected NYHA cardiac function grade Ⅳ Acute myocarditis, pericarditis, moderate or large amount of pericardial effusion, infective endocarditis, deep vein thrombosis, intracardiac thrombosis; Severe aortic stenosis, aortic aneurysm, thoracic aortic dissection, thoracic aortic aneurysm, after heart transplantation, metal heart valve replacement, pulmonary embolism patients undergoing thrombolysis and surgical bypass Patients with a history of mental illness, poor compliance and inability to cooperate.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| A composite of death, myocardial infarction, or cerebrovascular events | 24months | 24 months after the index procedure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All cause Death | 2 years | All-cause mortality 2 years after surgery |
| cardiac death | 2 years | Cardiac death 2 years after surgery |
| Expression level of miR-140-3p | 1, 2, 3, 6, 12 and 24 months | The expression levels of miR-140-3p in exosomes derived from endothelial progenitor cells (EPCs) were measured in peripheral blood collected from patients at 1, 2, 3, 6, 12 and 24 months |
| Cerebrovascular accident (CVA) | 2 years | Cerebrovascular accident 2 years after surgery |
| Major adverse cardiocerebral event (MACCE): death, MI, CVA, or any revascularization | 2 years | Major adverse cardiac and cerebral events 2 years after surgery |
| Myocardial infarction (MI) | 2 years | Myocardial infarction 2 years after surgery |
Contacts
Primary Contactli Xian-bin, master
Backup Contactma Yi-ming, Dr.
Outcome results
None listed