直接冠状动脉内支架置入术对急性心肌梗死无复流的影响

The effect of direct stenting on no-reflow in patients with acute myocardial infarction

目的评价直接冠状动脉(冠脉)内支架置入术对ST段抬高型急性心肌梗死无复流的影响.方法对157例ST段抬高型急性心肌梗死患者分别行直接冠脉内支架置入(直接支架组,85例)和球囊预扩张后支架置入(常规支架组,72例).比较两组介入治疗时平均X线曝光时间、造影剂用量、术后TIMI血流分级和心电图ST段变化.结果直接支架组和常规支架组比较,前者节省球囊,平均X线曝光时间和造影剂用量均显著降低[(24.6±16.9)min vs (34.4±17.5)min,(115±37)mL vs (166±61)mL;P均<0.05];二者术后TIMI 3级差异无统计学意义(91.8% vs 83.3%,P=0.107);前者TIMI 0～1级未见显著降低,但有明显的下降趋势(3.5% vs 11.1%,P=0.064);前者心电图ST段无回落发生率显著降低(22.4% vs 41.7%,P=0.009).结论对于ST段抬高型急性心肌梗死中适当的冠脉病变,直接冠脉内支架置入术不仅可以节省球囊,减少X线曝光时间和造影剂用量,而且可能减少无复流发生.

Objective To evaluate the effect of direct stenting on no-reflow in patients with ST-segment elevation (STEMI) acute myocardial infarction. Methods A total of 157 patients with STEMI received direct stenting (DS,n=85) or conventional post-dilation stenting (CS,n=72). The time of X-ray exposure, the amount of contrast media consumed, the TIMI grading after stenting and ST-segment changes of electrocardiogram were compared between two groups. Results The time of X-ray exposure and the amount of contrast media consumed were significantly less in DS group than those in CS group [(24.6±16.9) min vs (34.4±17.5) min, (115±37) mL vs (166±61) mL, P<0.05] additional to saving the use of balloons. Achievement of TIMI grade 3 after stenting had no significant difference in both groups (91.8% vs 83.3%, P=0.107). The rate of getting a TIMI grade 0-1 flow was not decreased in both groups, but there was a significantly descending trend in DS group (3.5% vs 11.1%, P=0.064). The rate of no ST-segment resolution in DS group decreased significantly (22.4% vs 41.7%,P=0.009). Conclusion For the properly selected lesions in STEMI, direct stenting may decrease not only the use of balloons but also the time of X-ray exposure, the amount of contrast media consumed and the rate of no-reflow.