直接经皮冠状动脉介入治疗应用抽吸导管的临床疗效观察

Efficacy of transcatheter aspiration of coronary thrombus in primary percutaneous coronary intervention for AMI

目的观察血栓抽吸导管在急性心肌梗死(AMI)患者中行直接PCI的疗效。方法选择我院因AMI住院行直接PCI,并于术中应用了血栓抽吸导管的患者共202例(抽吸组),另选择因AMI住院并行PCI的患者249例(对照组),比较两组即刻及近期临床疗效。结果抽吸组在发病距血管再通时间[(5.3±2.8)h vs (6.0±3.1)h,P=0.012]、直接支架置入率(44.1% vs 30.5%,P=0.003)和术后达TIMI 3级血流(90.1% vs 81.1%,P=0.008)的情况明显好于对照组,而无复流/慢血流发生率则明显减少(3.5% vs 8.4%,P=0.032)。术后抽吸组在肌钙蛋白I峰值[(44.7±31.2)μg/L vs (52.5±34.8)μg/L,P=0.012]及肌酸激酶同工酶峰值[(152.0±73.6)u/L vs (166.0±70.5)U/L,P=0.041]、即刻心电图的ST段回落率(67.8% vs 57.0%,P=0.002)、住院期间心力衰竭发生率(11.4% vs 22.9%,P=0.002)、再次心肌梗死发生率(1.0% vs 4.4%,P=0.044)、病死率(3.5% vs8.8%,P=0.032)等方面与对照组比较差异有统计学意义。结论 AMI患者行直接PCI过程中应用血栓抽吸导管可明显减少无复流/慢血流等并发症的发生,从而降低病死率,改善近期预后。

Objective To evaluate the efficacy of transcatheter aspiration of coronary thrombus during primary percutaneous coronary intervention（PCI） in patients with acute myocardial infarction（AMI）. Methods The patients with AMI undergoing primary PCI and receiving transcatherer aspiration thrombectomy（ n = 202） were enrolled in study group,and those who had AMI hut only received routine PCI（ n = 249）were enrolled in control group. The immediate and short-term outcomes between the two groups were observed. Results In the study group, both rate of direct implantation of stent and TIMI flow grade 3 obtained were superior to the control group,and significant difference in rate of no-reflow/slow flow was observed between the two groups. There were lower peak serum levels of cTnⅠ [（44.7±31.2） μg/L vs （52.5±34. 8） μg/L, P =0. 012] and CK-MB[（152. 0±73. 6） U/L vs （166.0±70. 5） U/L, P =0.041],and higher ST segment resolution rate（67.8% vs 57.0%, P =0. 002） in the study group. The heart failure rate（11. 4% vs 22.9%, P =0.002） ,re-infarction rate（1.0% vs 4.4%, P =0. 044） and fatality（3.5% vs 8.8%, P = 0. 032） in hospital were decreased in the study group compared with control group. Conclusion Transcatheter thrombus aspiration in patients with AMI was effective. It could decrease noreflow/slow flow and achieved good immediate and short-term clinical prognosis.