校正的TIMI帧数评估血栓抽吸在急性ST段抬高型心肌梗死中的疗效

Using corrected TIMI frame count to assess the effect of blood thrombus suction in acute ST-segment elevation myocardial infarction

目的探讨校正的心肌梗死溶栓试验(TIMI)帧数(CTFC)评估血栓抽吸在急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)中的临床疗效及短期预后。方法选取行急诊PCI治疗且再灌注成功TIMI血流分级恢复Ⅲ级的STEMI患者75例,根据是否行血栓抽吸分为血栓抽吸+PCI组(n=32)和常规PCI组(n=43)利用CTFC测定梗死相关动脉(IRA)血流,观察两组患者住院期间心功能参数及术后30天内心血管事件发生率。结果血栓抽吸+PCI组患者左前降支(LAD)及右冠状动脉(RCA)中的CTFC明显少于常规PCI组,差异具有显著性(P<0.05);两组患者左回旋支(LCX)中的CTFC比较差异无显著性。两组患者IRA再灌注成功后,在TIMI血流分级Ⅲ级的情况下,血栓抽吸+PCI组患者术后左室射血分数(LVEF)、肌酸激酶同工酶(CK-MB)峰值时间及30天内心血管事件发生率与常规PCI组比较差异均具有显著性(P<0.05),其中血栓抽吸+PCI组患者住院期间发生心源性死亡1例,因心肌梗死后心绞痛发作再次入院1例,常规PCI组患者住院期间发生心源性死亡4例,住院期间发生室性心动过速1例,因心绞痛发作再次入院1例,因严重心力衰竭入院1例,因非靶血管介入入院1例。两组患者住院天数比较差异无显著性。结论 CTFC可有效评价STEMI患者IRA再灌注情况及患者近期预后,有助于对患者进行危险分层和指导治疗。

Objective To investigate the validity of corrected TIMI frame count（CTFC） in assessing the short-term effect of thrombus suction in the patients with acute ST-segment elevation myocardial infarction（STEMI） undergoing primary percutaneous coronary intervention（PCI）. Method 75 STEMI patients undcrgoing primary PCI and achieving TIMI- Ⅲ grade flow were enrolled in this study. They were divided into PCI＋thrombus suction group and primary PCI group according to whether to thrombus suction. The patency and flow of infarct-related arteries（IRA） were analyzed by CTFC. Cardiac function during hospitalization and incidence of cardiovascular events within 30 days after primary PCI were also investigated in our study. Result CTFC of LAD and RCA in primary PCI ＋ thrombus suction group were significantly less than that in primary PCI group（P〈0.05）. There was no obvious difference in CTFC of LCX between the two groups. After successful reperfusion in IRA with TIMI- Ⅲ grade flow, LVEF, peak time of CK-MB and incidence of cardiovascular events within 30 days were significantly different between patients underwent primary PCI together with or without thrombus suction（P〈0.05）. In primary PCI ＋ thrombus suction group, 1 case of cardiac arrest occurred during hospitalization and 1 patient was re-hospitalized due to post-infarction angina. In primary PCI group, 4 cases of cardiac arrest and 1 case of ventricular tachycardia occurred duringhospitalization, one patient was re-hospitalized due to post-infarction angina, 1 patient was re-hospitalized due to severe heart failure and one patient was re-hospitalized due to interventional therapy for non-IRA. However, the length of hospital stay was similar between the two groups. Conclusion CTFC may be valuable to assess the efficacy of reperfusion therapy for IRA and the short-term outcome after reperfusion therapy in STEMI. It is also useful to make risk stratification and medical decision in STEMI patients.