Effect of drug treatment and selective percutaneous coronary intervention on myocardial collagen metabolism in patients with ST-elevation myocardial infarction / 中国医师进修杂志

ABSTRACT

Objective To investigate the effect of different treatment on ST-elevation myocardial infarction (STEMI) by evaluating the changes of myocardial collagen metabolism. Methods Forty-one patients with STEMI were divided into drug treatment group (22 cases) and selective percutaneous coronary intervention (PCI) group (19 cases). Meanwhile,47 healthy controls were included in control group. The levels of serum carboxy terminal propeptide of type Ⅰ procollagen (PⅠCP), precollagen Ⅲ ( PC Ⅲ ), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured by enzyme-linked immunosorbent assay at the 3rd ,6th, 12th, 18th month after STEMI,and compared with those in control group. Results The level of P Ⅰ CP in selective PCI group was significantly lower than that in drug treatment group at the 3rd, 6th month [( 15.08 ± 3.37 ) μ g/L vs. ( 19.78 ± 2.22 ) μ g/L, (23.88 ± 3.33 ) μg/Lvs. ( 30.00 ± 3.14) μ g/L, P ＜ 0.05], but there was no significant difference at the 12th and 18th month (P ＞0.05 ). The level of serum PC Ⅲ in selective PCI group was significantly lower than that in drug treatment group at the 3rd month [(50.70 ±4.83) ng/L vs. (59.91 ±4.64) ng/L,P ＜0.05],and there was no significant difference at others times between drug treatment group and selective PCI group. There was no significant difference in P Ⅰ CP/PC Ⅲ between drug treatment group and selective PCI group in all times(P ＞0.05). Compared with those in control group,the levels of serum MMP-1 in all times were significantly decreased in drug treatment group and selective PCI group(P ＜ 0.05 ), but there was no significant difference between drug treatment group and selective PCI group at same times (P ＞ 0.05). The level of serum TIMP-1was significantly higher in selective PCI group than that in drug treatment group at the 3rd and 6th month [(61.89 ± 11.44) μg/L vs. (52.23 ±4.97)μg/L, (62.85 ±6.31) μg/L vs. (52.97 ±6.43)μg/L,P＜0.05] ,and there was no significant difference in TIMP-1 between drug treatment group and selective PCI group in other times (P＞ 0.05). MMP-1/TIMP-1 in selective PCI group was significantly lower than that in drug treatment group at the 6th month [( 1.53 ± 0.25 )% vs. ( 1.95 ± 0.04)% ,P ＜ 0.05] ,and there was no significant difference in MMP-1/TIMP-1 between drug treatment group and selective PCI group in other times (P ＞0.05). Conclusions Selective PCI can improve myocardial collagen metabolism in patients with STEMI in short term ( ＜ 6 months), but it doesn't appear to be superior to drug treatment in long term (6 - 18 months). Patients with STEMI should enforce drug treatment if they have not been treated with PCI.