急性ST段抬高型心肌梗死急诊介入治疗中应用血栓抽吸器的临床研究

Application of Aspiration Thrombectomy Catheter in Emergent Percutaneous Coronary Intervention in Patients With Acute ST Segment Elevation Myocardial Infarction

目的:评价在急性ST段抬高型心肌梗死(STEMI)急诊介入治疗中应用血栓抽吸器的安全性和有效性。方法:选择2005年7月至2006年10月在我中心接受急诊经皮冠状动脉介入治疗的STEMI患者,使用血栓抽吸器者为抽吸器组(n=33),根据冠状动脉造影及临床情况从同期STEMI患者中选取条件相当者作为对照组(n=33),比较两组间的基础资料、术后即刻冠状动脉造影结果以及住院和随访期间情况。结果:两组间基础临床资料相似、抽吸器组支架直接置入率高、远端栓塞发生率低、校正的心肌梗死溶栓治疗临床试验帧数计数(cTFC)值小、心肌灌注分级3级获得率高,住院期间抽吸器组肌酸激酶MB同工酶和肌钙蛋白T峰值浓度较低,术后12小时心电图ST段回落幅度大,均显著优于对照组(P均<0.05～0.01);但两组间无/慢血流、术后心肌梗死溶栓治疗临床试验(TIMI)3级及两组住院期间主要心血管病事件发生情况未显示出统计学差异。结论:在血栓负荷较重的STEMI患者急诊介入治疗时,应用血栓抽吸器安全可行,可显著改善患者术后即刻的远端心肌组织微灌注,减少心肌酶的释放,但远期疗效还需进一步评价。

Objective： To evaluate the safety and efficacy of Diver C. E. aspiration thrombectomy catheter during emergency percutaneous coronary intervention（PCI） in patients with acute ST segment elevation myocardial infarction（STEMI）. Methods：The STEMI patients who undergoing emergent PCI and receiving Diver C. E. aspiration thrombectomy catheter from July 2005 to October 2006 （n = 33 ） were enrolled in study group, and those who had similar coronary angiography （CAG） and results basic characteristics but only received routine PCI were enrolled in control group（ n = 33 ）. The clinical data, CAG immediately after operation, and the follow-up data were compared between groups. Results ： There was no significent difference between two groups at baseline. The study group had more direct stent,less distal thrombosis ,less cTFC and more percentage of MBG 3 ,lower peak serum CK-MB and TnT levels ,faster ST segment resolution than the control group （P 〈 0. 05 ）. But the diffierences in no-floew, slow reflow, TIMI 3 and MACE were not significant. Conclusion： Application of Diver C. E. during emergent PCI in some patients with STEMI was safe and effective, which could improve distal myocardium perfusion and reduce myocardial damage, but the efficacy of long term need further judgement.