应用EXPORT血栓抽吸导管在急性ST段抬高型心肌梗死直接经皮冠状动脉介入治疗中的有效性观察

Efficacy of Thrombus Aspiration During Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction

目的:研究急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)中血栓抽吸对各项心肌灌注和临床指标的影响。方法:108例冠状动脉造影证实血栓负荷重的急性STEMI患者,随机分为血栓抽吸+PCI组(n=53)及传统PCI组(n=55),比较两组术后心肌梗死溶栓治疗临床试验(TIMI)血流分级、校正TIMI帧数、TIMI心肌灌注分级、ST段抬高回落百分比、血浆肌酸激酶MB同工酶、肌钙蛋白I峰值及术后30天主要心脏不良事件发生率的差别。结果:血栓抽吸+PCI组TIMI血流分级、校正TIMI帧数、TIMI心肌灌注分级、ST段抬高回落百分比均明显优于传统PCI组(P<0.05或0.01),且血浆肌酸激酶MB同工酶、肌钙蛋白I峰值显著低于传统PCI组(P<0.05),差异均有统计学意义。结论:STEMI直接PCI中应用血栓抽吸可以改善血流及心肌灌注情况、降低心肌标志物峰值。

Objective：To evaluate the efficacy of thrombus aspiration during primary percutaneous coronary intervention （PCI）for treating the patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods：A total of 108 patients with coronary angiography confirmed acute STEMI and heavy thrombus load were summarized. The patients were randomized into two groups, Experimental group, n = 53, the patients were treated by primary PCI plus thrombus aspiration, and Control group, n = 55, the patients received conventional PCI. The TIMI blood flow, corrected TIMI frame, TIMI grade, ST-segment elevation recovery and the peak values of plasma creatine kinase MB （ CK-MB ） and cardiac troponin I （CTNI） were assessed and compared between two groups. Results：Compared with Control group, the Experimental group presented significantly improved post-procedural TIMI blood flow, corrected TIMI frame,TIMI grade blood flow, and the better recovery of ST-segment elevation,P〈0. 05 or P〈0. 01. The patients in Experimental group also showed obviously lower peak values of CK-MB and CTNI,P〈0. 05. Conclusion：Primary PCI plus thrombus aspiration could improve myocardial reperfusion, decrease the peak value of plasma CK-MB and CTNI in patients with acute STEMI.