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Background Acute myocardial infarction (acute myocardial infarction, AMI) after the body start various compensatory mechanisms, open at the same time the process of left ventricular remodeling (left ventricular remodeling, LVRM), myocardial infarct zone wall thinning, elongated produce \, In addition to the structure of the myocardial cells, metabolic and functional abnormalities in the process of ventricular remodeling after myocardial infarction, myocardial extracellular matrix (extracellular matrix, ECM) abnormal changes. ECM is present in the cells between the dynamic mesh structure, composed by macromolecules such as collagen, proteoglycans and glycoprotein involved in a variety of physiological and pathological processes. Cardiac collagen matrix arrangement, the coordination of myocardial contractility and maintaining left ventricular geometry plays an important role for the maintenance of the myocardial cells. ECM components in the dynamic balance of degradation and reorganization in the hydrolysis of matrix metalloproteinases (matrix metalloprotein-ases, MMPs), metalloproteinase inhibitors (tissue inhibitors of metalloproteinases, TIMPs) specific inhibition of MMPs endogenous agent. Coronary revascularization and myocardial reperfusion therapy such as thrombolysis and primary percutaneous coronary intervention (percutaneous coronary intervention, PCI) implemented as soon as possible to salvage ischemic myocardium, can most effectively reduced infarct size and protect the left ventricular function. The purpose of this study was to comparison emergency PCI, the delayed PCI and conservative treatment, three different treatment options for patients with acute myocardial infarction ventricular remodeling and cardiac function; reflect the expression of matrix metalloproteinases and their inhibitors in patients with acute myocardial infarction, and its relationship with ventricular remodeling and cardiac function after myocardial infarction; reveal MMP-9, TIMP-1 predict ventricular remodeling and cardiac function after myocardial infarction; further explore whether other PCI for a role in the prevention of ventricular remodeling molecular biology mechanism further illustrate their matrix metalloproteinases and their inhibitors expression. The purpose of a comparative study of emergency PCI delayed PCI and conservative treatment, the impact of three different treatment regimens for acute myocardial infarction in patients with left ventricular remodeling, and to guide clinical treatment, there is a reasonable choice in favor of the treatment program. 2 study in patients with acute myocardial infarction matrix metalloproteinase inhibitor expression and its relationship with left ventricular remodeling and cardiac function after myocardial infarction. MMP-9, TIMP-1 expression changes measured with color Doppler ultrasound and cardiac function related indicators of relations: left ventricular internal diameter, left ventricular end-diastolic and end-systolic volume (EDV and ESV), left ventricular ejection fraction (LVEF), mood aneurysm formation. Which reveals MMP-9, TIMP-1 on ventricular remodeling and cardiac function after myocardial infarction predictive role as the assessment basis. Study PCI for acute myocardial infarction in patients with left ventricular remodeling mechanism of the preventive effect of matrix metalloproteinases and their inhibitors expression. Reperfusion therapy is the the AMI treatment of key AMI early treatment of the most important of reperfusion therapy as soon as possible, PCI can limit infarct size, recovery of hibernating myocardium perfusion, and promote the healing of the infarcted area, to prevent the extension of the infarcted myocardium and ventricular remodeling. In addition, the study will further explore the PCI for the prevention of ventricular remodeling with or without other molecular biological mechanism, to further clarify its MMPs system. Method 1, the study objects and grouping the period from March 2010 to November 2010 in Wuhan General Hospital Department of Cardiology, hospitalized for the first time to the onset of AMI in 98 patients were male and 70 cases (71.4%) and 28 females (28.6%). The incidence of patients admitted within 12h 51 patients were given emergency PCI (A group), 22 cases of patients after 12 hours of onset delayed PCI (B group) and 25 patients with conservative medical treatment (C group). Same period in coronary angiography showed no significant stenosis 20 cases for a normal control group (D). AMI groups, age, gender, comorbidities, risk factors, myocardial infarction typing and myocardial infarction parts there was no significant difference, comparable. Inclusion criteria were: 1, acute myocardial infarction: the typical symptoms of chest pain; electrocardiogram two contiguous leads ST segment elevation chest leads ≥ 0.2mV limb leads ≥ 0.1mV; creatine kinase greater than normal more than twice; in any of the above three conditions two; (2) diabetes diagnostic criteria of the American Diabetes Association ADA2007: the patient's previous use of oral hypoglycemic agents and / or insulin (subcutaneous) or twice a fasting blood sugar ≥ 7.0mmol / L, the diagnosis of diabetes; (3) hypertension diagnosis using the 1999 World Health Organization / International Society of Hypertension League (WHO / ISH) standard: in the case of the use of anti-hypertensive drugs, systolic blood pressure ≥ 140mmHg, diastolic blood pressure ≥ 90mmHg; previous history of hypertension, currently using anti-hypertensive drugs, now that the blood pressure does not exceed the above level, should be diagnosed as having high blood pressure; (4) the diagnostic criteria of high cholesterol dyslipidemia countermeasures thematic group \The proposed standard: TC ≥ 5.72 mmol / L; TG ≥ 1.7mmol / L; LDL ≥ 3.64mmol / L; HDL ≤ 0.91 mmol / L. Exclude standards: old myocardial infarction recurrent acute myocardial infarction, thrombolysis, connective tissue disease, secondary to cardiac rupture, cardiac perforation, chordal rupture, severe valvular disease, traumatic cardiopulmonary resuscitation, serious liver and kidney dysfunction, activities bleeding, contrast agent allergy, trauma, malignancy, major surgery, a variety of infections, the PCI surgery is not successful and can not clear the persistent chest pain originating time. PCI success criteria: (1) coronary angiography showed a residual stenosis of vascular lesions lt; 20%; (2) TIMI flow grade 3: (3) The patient's symptoms improved significantly; (4) no acute complications (emergency surgery, myocardial infarction or cardiac death); (5) during hospitalization, no serious cardiac events (cardiac death, myocardial infarction, or re-revascularization). 2 Methods 2.1 collected for each patient history of symptoms, physical examination, check myocardial enzymes and ECG. If there is no taboo in all patients given intensive medical therapy, including: aspirin, clopidogrel, nitrates, angiotensin converting enzyme inhibitors or angiotensin receptor blockers, beta-receptor blockers, statins drop lipid drug. A group of patients given immediately after admission, aspirin, enteric-coated tablets (Aspirin) 300mg chewable, clopidogrel (Plavix) 600mg orally, in the cath lab for coronary angiography, the infarct-related artery lesion PCI (Innova 2000 heart angiography). Group B elective delay PCI C group were treated with conservative medical treatment. After PCI in patients taking aspirin 300mg orally / day, Plavix 75mg oral / day, three months later reduced to aspirin 100mg 1 / day (insist on taking), and Plavix 75mg 1 / day (recommended taking at least one year). (Follow-up period insist on taking) 2.2, coronary interventional procedures by the Department of Cardiology specialist, according to the American College of Cardiology and the American Heart Association (ACC / AHA) coronary angiography guide the Judkins catheter line multi-angle, multi-faceted options coronary angiography, coronary segment full visual diameter stenosis ≥ 70% judged the target lesion. Right femoral artery or radial artery approach to coronary DES implantation. Stenting after visual the original stenosis lt; 20% and get TIMI3 level of blood flow (CAG evaluation), compared to surgical success. 2.3 Observation and evaluation of: (1) A hospital immediately incidence 12h, 7d, 90d puncture collected peripheral venous blood 6ml, centrifuged for 10 minutes immediately 3000r/min; immediately sent to the hospital medical test subjects, the use of quality control are qualified automatic biochemical measurements detected in plasma total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG). The supernatant was stored at -80 ℃ refrigerator under test. Enzyme-linked immunosorbent assay (ELISA) in strict accordance with the reagent instructions measured serum of MMP-9 (detection range 0-10ng/ml), TIMP-1 (detection range 0-10ng/ml) reagents from Wuhan Boster Biological Engineering Co., Ltd. available. (2) All patients admitted to hospital after 7-10 days and 3 months when the two-dimensional ultrasound echocardiography and cardiac function measuring indicators (instruments used for the Agilent HP5500 cardiac ultrasound diagnostic apparatus, the probe frequency 2-4MHz). Application of dual-plane Simpson method to calculate the left ventricular end-diastolic and end-systolic volume (EDV and ESV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd), observe whether cardiac aneurysm formation. 3 Statistical analysis using SPSS 13.0 statistical package for statistical analysis, the measurement data are expressed as x ± s. Measurement data among the three groups were compared using one-way ANOVA (One-Way ANOVA), pairwise comparisons the the Games Howell Act (unequal variances) or LSD method (homogeneity of variance), within the group before and after treatment at different times for comparison repeated measurements or paired t test. Count data were compared using the chi-square test. Correlation analysis between the indicators with linear correlation analysis (Pearson linear correlation analysis). P lt; 0.05 for statistical difference significant meaning. Tabulation and describe the experimental results. 1 admission baseline data comparison among the four groups, each group's age, gender, comorbidities, risk factors, myocardial infarction typing, MI site was no significant difference between comparable. 2, MMP-9 and TIMP-1 test results of serum MMP-9 and TIMP-1 concentrations in hospitalized the immediate three groups of patients were significantly higher than the normal control group (3.07 ± 0.87,131.4 ± 39.41, P lt; 0.05). Group A average after PCI MMP-9 concentration increased again returned to admission levels at 7d, MMP-9, B, C group a significant difference (P lt; 0.05), and TIMP-1 to 7d with no significant difference in the admission level, higher than that of the control group, 90d decline. Group B, MMP-9 concentration in 7d still significantly higher than the time of admission, 90d dropped to the admission level, compared with C group were significantly different (P lt; 0.05), TIMP-1 concentration is always higher than 90d concentration admission decline. Group C, MMP-9 concentration is always higher than the admission and the control group, and TIMP-1 concentrations 90d began to decline, but still higher than the normal control group. 3 ultrasound heart diagram analysis results onset 7d, left ventricular ejection fraction (LVEF), EDV, ESV, LVDd A, B, C three groups without significant with differences; incidence 90d when EDV, ESV and LVDd in A, group B is less than C group, and there are significant sexual significance (P lt; 0.05); 90d when LVEF in the A, group B is greater than C group, and the significant significance (P lt; 0.05); A, group B LVEF, EDV, ESV and LVDd without significantly with sex differences ( P gt; 0.05). A, group B EDV ESV, LVDd in 90d reduced compared 7d and statistically significant; LVEF improved but there was no significant difference; the C group EDV, ESV, LVDd in 90d increase when compared to 7d and significant differences, LVEF decline and there are significant differences. A, B, C three groups aneurysm formation ratio was no significant difference compared 7d; 90d increased but there was no significant difference. 4 expression of MMP-9 concentration and cardiac ultrasound check results related to sex all patients with onset at 7d MMP-9 concentration and 90d when EDV was significantly with being related (r = 0.261, P lt; 0.05), and ESV was significantly positive related (r value 0.340 , P lt; 0.05), and LVEF was a significant negative correlation (r = -0.218, P lt; 0.05), with LVDd no significant correlation (r = 0.118, P gt; 0.05). Conclusions The results show that: 1, AMI early serum MMP-9 concentration increased, persist for a week to a few months, reperfusion therapy can reduce the concentration of MMP-9, shorten its duration; 2, ventricular remodeling process after myocardial infarction , MMP-9 concentration and EDV, ESV was positively correlated with LVEF was negatively correlated with the concentration of MMP-9 may be able to serve as predictors of ventricular remodeling after AMI incidence and myocardial infarction; emergency PCI treatment as soon as possible to open the blood vessels to improve the heart of crime , delayed PCI can still inhibit ventricular remodeling; 4, acute myocardial infarction ventricular remodeling early than LVEF, EDV, ESV, LVDd and more sensitive to the rate of aneurysm formation.
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