远端血管保护装置在急性ST段抬高心梗中的应用

Application of distal embolic protection device in acute myocardial infarction with ST-segment elevation

目的评价远端血管保护装置(DPD)在急性ST段抬高心梗中的应用价值。方法回顾性分析2004年1月1日-2005年12月31日第四军医大学西京医院心内科收治的267例急性ST段抬高心梗患者行急诊PCI的相关临床资料。其中常规PCI(对照组)169例,PCI术中使用DPD(实验组)98例。比较两组术中无复流发生率、心肌梗死溶栓治疗(TI MI)3级血流比例、术后ST段回降率、住院死亡率、术后1周左室射血分数(LVEF)等指标。结果DPD组无复流发生率、TI MI 3级血流比例、术后ST段回降率分别为3.06%(3例)、93.88%(92例)、94.90%(93例),对照组分别为13.61%(23例)、77.51%(131例)、84.02%(142例),两组比较差异显著(P<0.05)。两组间住院期间死亡率、术后1周LVEF比较无显著性差异。结论在急性ST段抬高心梗急诊PCI术中应用DPD能明显减少无复流发生率,改善TI MI血流,而对住院死亡率、PCI术后近期心功能改善的影响有待进一步研究。

Objective To evaluate the efficacy and safety of distal embolic protection device （DPD） on acute myocardial infarction （AMI） with ST segment elevation. Methods Two hundred and sixty-seven patients with ST segrnent elevation AMI treated in emergency with percutaneous coronary intervention （PCI） from Jan. 1, 2004 to Dec. 31, 2005 in the Department of Cardiology, Xijing Hospital were studied retrospectively. 169 patients were included in control group and 98 in DPD group. Patients in control group were treated with emergency PCI, while those in DPD group were treated with DPD during emergency PCI. The incidence of ＂no-reflow＂ phenomenon, thrombolysis in myocardial infarction （TIMI） 3 flow, and ST segment resolution were observed, and mortality imhospital and left ventricular ejection fraction （LVEF） at 1 week after PCI were compared between the two groups. Results The incidence of ＂no-reflow＂ was 3.06% （3/98） in DPD group and 13. 61% （23/169） in control group （P〈0.05）. TIMI 3 flow was 93.88% （92/98） in DPD group and 77. 51% （131/169） in control group （P〈0. 05）. ST segment resolution was 94. 90% （93/98） in DPD group and 84. 02% （142/169） in control group （P〈0. 05）. No significant differences existed between the two groups on in-hospital mortality and LVEF at 1 week after PCL. Conclusions DPD can effectively protect the distal vessels against thrombus and improve the TIMI flow grade, reduce the incidence of no-reflow phenomenon in emergency PCI in patients with ST segment elevation AMI. But the effect of application of DPD on long-term in hospital mortality and LVEF of the patients with ST segment elevation AMI needs to be further investigated.