血栓抽吸治疗在急性ST段抬高心肌梗死直接介入治疗中应用的安全性和有效性研究

Study on safety and efficiency of thrombus aspiration during primary PCI for acute ST-segment elevation myocardial infarction

目的:评价血栓抽吸治疗在急性ST段抬高心肌梗死(STEMI)直接经皮冠状动脉介入治疗术(PCI)中应用的安全性和有效性。方法:59例STEMI患者被随机分为血栓抽吸组和传统PCI组(对照组),对2组之间的冠状动脉造影结果(TIMI3级血流率、校正TIMI帧数、TMP分级)、心电图ST段回落百分比(sumSTR)和临床结果[肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)峰值、术后1周左室射血分数(LVEF)、6个月主要不良心血管事件]进行分析比较。结果:血栓抽吸组PCI后梗死相关动脉TIMI3级血流率、TMP3级及sumSTR>70%发生率均显著高于对照组,校正TIMI帧数、TMP0～1级及sumSTR<30%均显著低于对照组。血栓抽吸组CK、CK-MB峰值显著低于对照组,术后1周LVEF显著高于对照组。随访6个月主要不良心血管事件2组差异无统计学意义。结论:在急性STEMI直接PCI中应用血栓抽吸治疗是安全有效的,能够改善心肌灌注,降低心肌梗死面积,提高LVEF。

Objective：This study attempts to investigate the safety and efficiency of thrombus aspiration during primary percutaneous coronary intervention （PCI） for acute ST-segment elevation myocardial infarction. Method：A total of 59 patients were assigned to the thrombus-aspiration group or the conventional-PCI group. We assessed angiographic （TIMI Ⅲ blood flow, corrected TIMI frame, TMP grade） and electrocardiographic signs（sum-STR） of myocardial reperfusion, as well as clinical outcome （peak values of CK and CK-MB, LVEF in one week after PCI, clinical outcomes up to 6 months after PCI）. Result：The thrombus-aspiration group had a significantly higher rate of post-procedural TIMI Ⅲ blood flow as compared with conventional-PCI group （P=0. 033）. The thrombus-as- piration group had a significantly lower corrected TIMI frame number as compared with conventional-PCI group （P =0. 001）. Patients in thrombus-aspiration group had a higher rate of TMP grade 3 blood flow after PCI （P= 0. 007） while a lower rate of TMP grade 0-1 blood flow （P=0. 030） as compared with those in conventional-PCI group. More patients in thrombus-aspiration group had sumSTR〉70% （P= 0. 019） at 1 hour after PCI, while fewer patient in thrombus-aspiration group had sum STR〈30% （P=0. 030） as compared with those in conventional-PCI group. Patients in the thrombus-aspiration group had significantly lower peak values of CK and CK-MB as compared with those in conventional-PCI group （P〈0. 001）. Patients in the thrombus-aspiration group had signif- icantly higher LVEF （P=0. 001） in a week after PCI as compared with those in conventional-PCI group. Clinical outcomes up to 6 months after PCI were no significant difference between two groups. Conclusion：Thrombus aspiration is applicable in patients with myocardial infarction with ST-segment elevation, and it results in better reperfusion higher LVEF and clinical outcomes than conventional PCI.