IVUS在STEMI患者急诊介入诊疗中的应用

The IVUS application research of the STEMI patients in the emergency diagnosis and treatment

目的探讨血管内超声(IVUS)在ST段抬高型心肌梗死(STEMI)患者急诊介入诊疗中的应用。方法选择冠状动脉造影(CAG)提示心肌梗死相关血管(IRA)固定狭窄为临界病变的STEMI患者80例,发病在12小时内,并且远端血流TIMIⅢ级;随机分为IVUS组(试验组)38例和未行IVUS组(对照组)42例;对照组全部置入支架,试验组进一步经IVUS评价病变分为低危和高危患者,决定是否置入支架;观察两组患者住院期间、术后1个月、3个月、6个月、1年心脏主要不良事件发生率,左心室舒张末期内径(LVEDD)及射血分数(EF)值的变化,支架置入的个数。结果两组患者住院期间、术后1个月、3个月、6个月、1年心脏主要不良事件发生率比较无明显差异,两组LVEDD及EF值比较无明显差异(P>0.05);试验组比对照组支架置入的个数减少,差异有显著性(P<0.05)。结论在IVUS指导下的急诊介入诊疗中,STEMI低危患者不置入支架也是安全的、可行的,减少了患者支架置入数量。

Objective Explore intravascular ultrasound (IVUS) in patients with acute ST-segment elevation myocardial infarction (STEMI) in the application of emergency intervention. Methods Eighty patients within 12 h of a STEMI episode , who had ifxed stenosis (50%to 75%stenosis) of infraction related artery(IRA) by the coronary angiography (CAG) identiifed as the coronary intermediate lesion ,accompanying with a TIMI 3 lfow at the distal end of the coronary artery, were included. These patients were randomly divided into the IVUS (test group, n=38) and non-IVUS groups (control group, n=42). All the patients in the control group were implanted the stent, while the test group was further divided into the low-risk patients and high-risk patients according to the evaluation of IVUS, and then decided whether implanting the stent or not. We observed the incidence of the major cardiovascular events, the change of the left ventricular end diastolic diameter (LVEDD) and ejection fraction (EF), the number of stents implantation among the hospitalisation and 1, 3, 6 and 12 months after the surgery. Results There were no statistical signiifcant differences of incidence of adverse cardiac events, LVEDD and EF between the two groups among the hospitalisation and 1, 3, 6 and 12 months after the surgery (P>0.05). The number of stents implantation in the test group was signiifcantly less than the control group (P<0.05). Conclusion Under the guide of IVUS in emergency intervention, it was safe and feasible for the low-risk STEMI patients without stent implantation, reducing the stent implantation.