急诊PCI联合远端保护装置或GPⅡb/Ⅲa治疗血栓负荷过重的ST段抬高型心肌梗死

Treating acute ST elevation myocardial infarction with PCI combined with distal protection devices or glycoprotein Ⅱb/Ⅲa receptor inhibitors in patients of high-burden thrombus

目的探讨直接经皮冠状动脉介入治疗(PCI)联合远端保护装置(DPD)或血小板Ⅱb/Ⅲa受体拮抗剂(GPⅡb/Ⅲa)治疗血栓负荷过重的急性ST段抬高型心肌梗死(STEMI)。方法冠状动脉造影(CAG)显示冠脉内富含大量血栓者106例,按时间及介入治疗方法分常规PCI组(37例)、DPD组(34例)和GPⅡb/Ⅲa组(35例),回顾性分析三组PCI术后即刻梗死相关血管(IRA)的TIMI血流分级、梗死部位心肌灌注水平(TMP)分级、术后72h内出血、输血比例及术后30d、1年内主要心脏不良事件(MACE)发生情况。结果常规PCI组、DPD组和GPⅡb/Ⅲa组术后即刻IRA的TIMI血流分级分别为(2.41±0.50)、(2.65±0.48)和(2.68±0.47),TMP分级分别为(2.03±0.65)、(2.31±0.48)和(2.37±0.54),术后30d,1年MACE发生率分别为(16.2±37.4)%、(8.6±28.4)%和(7.9±2.7)%,(29.7±46.3)%、(14.3±35.5)%和(18.4±39.3)%。DPD组和GPⅡb/Ⅲa组以上指标均优于常规PCI组(P<0.05)。术后72h内出血、输血情况三组间差异无统计学意义。结论冠脉内血栓负荷过重的STEMI患者急诊PCI中使用DPD或GPⅡb/Ⅲa安全、有效,即刻获得的TIMI血流和心肌灌注优于常规PCI。

Objective To compare the efficacy and safety of distal protection devices（DPD） and glycoprotein 2b/3a receptor inhibitors （GP Ⅱb/Ⅲa）-tirofiban for treating acute ST elevation myocardial infarction （STEMI） during primary interventional therary （PCI） in the patients with high- burden thrombus in the infract-related artery （IRA）. Methods High-burden thrombus formation in the IRA was found in 106 patients with acute STEMI,who were divided into 3 groups of conventional PC1 group（A）,DPD group（B） and GP Ⅱb/Ⅲa group（C）. The TIMI flow grade and TIMI myocardial perfusion （TMP） grade of the IRA were assessed immediately after the performance of PCI, and the 30-day and 1-year major adverse cardiac events （MACEs）, bleeding and transfusion were evaluated. Results The TIMI flow grades of groups of A,B and C were 2.41±0.50,2.65±0.48 and 2.68±0.47,TMP grades were 2.03±0.65,2. 314±0.48 and 2.37±0.54,MACEs for 30 days were （16.2±37. 4）%,（8.6±28.4）% and （7.9±2.7）%,and MACEs for 1-year were （29.7±46.3）%, （14.34±35.5）% and （18.4±39.3）%, respectively, The above values were better in groups of B and C than those in group A （P〈0.05）, The bleeding and transfusion within 72 hours were not significantly different among 3 groups. Conclusion DPD and GP Ⅱb/Ⅲa were effective and safe for treating STEMI in the patients with high-burden thrombus in the IRA with better TIMI flow grade and TMP grade than those in conventional PCI.