联合应用溶栓治疗和血栓抽吸对ST段抬高型AMI患者急诊PCI后无复流的影响

Effects of combined application of thrombolytic therapy and aspiration thrombectomy on no-reflow phenomenon in patients with ST-segment elevation acute myocardial infarction after primary percutaneous coronary intervention

目的评价联合应用溶栓治疗和血栓抽吸对ST段抬高型急性心肌梗死(AMI)患者急诊冠状动脉介入治疗(PCI)后无复流的影响。方法纳入2007-2010年在发病24h内成功进行急诊PCI的534例ST段抬高型AMI患者,分为4组:A组(n=260),未应用溶栓治疗和血栓抽吸;B组(n=96),进行溶栓治疗;C组(n=143),进行血栓抽吸;D组(n=35),联合应用溶栓治疗和血栓抽吸。收集所有患者的临床、冠状动脉造影和PCI相关资料以评价联合应用溶栓治疗和血栓抽吸对无复流的影响。结果在534例患者中,发生无复流138例(25.8%),A、B、C、D组无复流发生率分别为32.7%(85/260)、20.8%(20/96)、21.7%(31/143)和5.7%(2/35),各组间比较差异有统计学意义(P=0.009)。结论联合应用溶栓治疗和血栓抽吸可显著降低ST段抬高型AMI患者急诊PCI术后无复流发生率。

Objective To assess the effects of combined application of thrombolytic therapy and aspiration thrombectomy on no-reflow phenomenon in patients with ST-segment elevation acute myocardial infarction （AMI） after primary percutaneous coronary intervention （PCI）. Methods Five hundred and thirty four patients with ST-segment elevation AMI,admitted from 2007 to 2010 and successfully treated with primary angioplasty within 24 hours after the onset of AMI,were divided into 4 groups：A group （without thrombolytic therapy combined with aspiration thrombectomy treatment）,B group （only thrombolytic therapy）,C group （only aspiration thrombectomy） and D group （treated with thrombolytic therapy and aspiration thrombectomy）. All clinical,angiographic and procedural data were collected. Multiple logistic regression analysis was used to identify the related predictors of the no-reflow phenomenon. Results The no-reflow phenomenon was found in 138 （25.8%） of 534 patients. The incidence of no-reflow phenomenon in A,B,C,and D group was 32.7% （85/260）,20.8% （20/96）,21.7% （31/143） and 5.7% （2/35） （P=0.009）,respectively. Conclusion Combined application of thrombolytic therapy and aspiration thrombectomy may significantly decrease the incidence of no-reflow phenomenon in patients with ST-segment elevation AMI and treated with primary PCI.