血栓抽吸在老年急性ST段抬高型心肌梗死患者直接介入治疗中的应用

Thrombus aspiration during primary percutaneous coronary intervention in elderly patients with ST-elevation myocardial infarction

目的:探讨经皮冠状动脉内血栓抽吸术在血栓负荷重的急性ST段抬高型心肌梗死老年患者直接介入治疗(PCI)中的应用。方法:选择2009-01-2010-12期间在我院接受直接PCI的急性ST段抬高型心肌梗死老年患者117例,其中直接介入术加血栓抽吸治疗者为血栓抽吸组,共44例;仅行常规直接PCI者73例为对照组。研究初级终点为术后TIMI 3级血流率,次级终点为随访6个月的左心室射血分数(LVEF)、主要心血管病事件(MACE)发生率及纽约心功能分级。结果:血栓抽吸组术后TIMI 3级高于对照组,达到95.5%,术后肌酸激酶同工酶及TnI达峰时间稍提前于对照组,但与对照组比较均差异无统计学意义;随访6个月结果显示,累计MACE发生率在血栓抽吸组和对照组分别为4.6%和9.5%,差异无统计学意义,LVEF在住院1周时血栓抽吸组及对照组分别为[(51.4±9.2)%︰(48.0±11.8)%,P>0.05],随访6个月时分别为[(54.5±6.8)%︰(49.9±10.5)%,P<0.05];6个月时血栓抽吸组纽约心功能分级优于对照组,但差异无统计学意义。结论:血栓抽吸可以改善血栓负荷重的老年患者急诊PCI术后TIMI血流,并可明显改善6个月时LVEF,可能对预后产生积极作用。

Objective：To evaluate the effect of thrombus aspiration on primary percutaneous coronary intervention（PCI） in elderly patients with acute ST-elevation myocardial infarction（STEMI）.Method：The tatal of 117 STEMI elderly patients underwent primary PCI from January 2009 to December 2010.Forty-four patients who received PCI and thrombus aspiration were enrolled in study group and 73 patients who only received primary PCI were enrolled in control group.Count the amount of TIMI-3 patients as the primary endpoint,measure left ventricular ejection fraction（LVEF）,major adverse cardiac event（MACE） and NYHA cardiac function grading six month later as the secondary endpoint,were compared between the two groups.Result：TIMI-3 was achieved in 95.5% of patients in thrombus aspiration group,without significant difference between two groups.The peak time of CK-MB and TnI was earlier ahead the schedule in thrombus aspiration group,without significant difference between two groups either.The rate of MACE was 4.6% in the study group and 9.5% in the control group after six months（P0.05）.Compared with control group,LVEF of the study group were improved after six months（[51.4±9.2]% vs [48.0±11.8]%,P0.05;[54.5±6.8]% vs [49.9±10.5]%,P0.05）.The study group had a higher NYHA cardiac function grading than the control group,with no significant difference.Conclusion：Thrombus aspiration can improve myocardial reperfusion in STEMI patients with heavy thrombus burden,increase the LVEF after six months,which may bring out a positive prognosis.