血栓抽吸导管(DIVER^(TM))在急性心肌梗死急诊冠状动脉介入治疗中的应用

Clinical application of thrombus aspirated catheter (DIVER^(TM)) in primary PCI for acute myocardial infarction

目的评价急性心肌梗死急诊冠状动脉介入治疗(PCI)中应用血栓抽吸导管(DIVERTM)的临床疗效与安全性。方法选择2005年3月至2006年4月符合急诊PCI治疗条件的急性心肌梗死患者共74例,入选患者梗死相关血管(IRA)100%闭塞伴冠状动脉内血栓,开通IRA后均置入西罗莫司药物涂层支架。其中36例(A组)将0.36mm(0.014in)BMW冠状动脉导丝送至闭塞血管远端,沿该导丝送入血栓抽吸导管(DIVERTM),持续负压下从血管近端至远端缓慢推抽2~3次,造影提示血栓影消失后直接置入支架;另外38例(B组)按常规方法完成PCI术。比较两组间血管开通率、无复流发生率、住院期间及出院后半年内心血管事件发生率。结果两组冠状动脉造影显示的血管开通率均为100%,A组无复流发生率及住院期间主要不良心脏事件发生率明显低于B组(2.78%比21.05%,2.78%比10.53%,P均<0.05)。平均随访3.2±1.4个月,随访率93.5%,两组半年内心血管事件发生率均为0。结论在急性心肌梗死急诊PCI中应用血栓抽吸导管(DIVERTM)安全可行,操作简单,能够明显减少冠状动脉内血栓,降低无复流和住院期间心血管事件发生率,其临床效果优于普通治疗组。

Objective To evaluate the clinical effect and safety of the thrombus aspirated catheter （ DIVERTM ） in primary PCI for acute myocardial infarction. Methods Seventy four AMI patients with total occluded infarct-related coronary artery（IRA） and intra-coronary thrombus from March 2005 to April 2006 were divided into two groups according to admission time and the treatment they received. After the 0. 014 in BMW coronary wire crossed the lesion, the thrombus aspirated catheter （ DIVERTM ） was advanced over the wire to the lesion and continuously aspirated 2 - 3 times until the thrombus disappeared and stents were directly implanted in patients in group A （n = 36） admitted from December 2005 to April 2006. Routine PCI applied in patients in group B （ n = 38 ） admitted from March 2005 to December 2005. Sirolimus eluting stents were implanted in both groups. The artery re-opened rate, no-reflow rate and the rate of major adverse cardiac events during hospitalization and 6 months after discharge were compared between two groups. Results Coronary arteriography showed the artery re-opened rate was 100% in both groups. The rates of no-reflow and major adverse cardiac events during hospital stay were significantly lower in group A than those in group B （2. 78% vs 21.05% and 2.78% vs 10.53% respectively,P 〈0.05）. Within the post-discharge follow-up of 6 months, the rate of major adverse cardiac events remained nill in both groups. Conclusion Compared with routine therapy, the application of thrombus aspirated catheter （ DIVERTM ） in primary PCI for acute myocardial infarction was feasible and provided better clinical efficacy.