血栓抽吸对急性心肌梗死直接经皮冠状动脉介入治疗时球囊后扩张后冠状动脉血流的影响

Effect of thrombus aspiration on coronary flow after post-stenting balloon dilation during primary percutaneous coronary intervention for patients with acute ST-segment elevation myocardial infarction

目的探讨直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前应用血栓抽吸处理是否有助于改善支架置入后球囊后扩张(post-stenting balloon dilation,PSBD)后的冠状动脉血流程度。方法回顾性分析814例接受直接PCI的ST段抬高急性心肌梗死患者资料,入选接受PSBD的患者146例。根据支架置入前是否进行血栓抽吸操作分为抽吸组(57例)和对照组(89例)。比较两组的基线特征、冠状动脉病变及介入治疗情况、术后即刻冠状动脉TIMI血流、心肌灌注分级(myocardial blush grade,MBG)及90 min时心电图ST段回落程度。结果两组患者基线资料及冠状动脉造影结果比较,差异均无统计学意义。抽吸组术后即刻TIMI血流Ⅲ级(73.7%比60.7%)和MBG分级Ⅲ级(49.1%比47.2%)获得率高于对照组,但差异均无统计学意义(均P>0.05)。术后90 min两组心电图ST段回落程度(ST-segment resolution,STR)≥70%获得率比较,差异无统计学意义(47.4%比41.6%,P=0.49)。两组术后30 d无主要不良心脏事件生存率比较,差异无统计学意义(93.0%比89.9%,P=0.51)。结论急性心肌梗死直接PCI患者血栓抽吸并未改善PSBD后冠状动脉血流及30 d临床预后,对于急诊PSBD,仍需寻找其他方法以期改善术后即刻血流。

Objective Post-stenting balloon dilation （PSBD） is widely recommended to optimise stent expansion and reduce long-term adverse events, however, its use during primary percutaneous coronary intervention （PCI） remains controversial. The objective of this study is to investigate whether thrombus aspiaration （TA） before stent implantation could counteract the potential harmful effects in increasing no/ slow flow by PSBD during primary PCI for acute ST-segment elevation myocardial infarction （STEMI） . Methods A total of 814 consecutive STEMI patients received primary PCI were retrospectively screened, and 146 patients treated by PSBD were enrolled. Among them, 57 patients received TA before stent implantation and PSBD during primary PCI （TA group） , and the remaining 89 patients treated with PSBD only were served as control group. Thrombolysis in Myocardial Infarction （TIMI） flow and myocardial blush grade （MBG） in culprit vessel immediately after the procedure, degree of ST-segment resolution （STR） 90 minutes after the procedure and major adverse cardiac events （MACE） at 30 d clinical follow-up were compared between the two groups. Results Baseline clinical and angiographic characteristics were comparable between the two groups. No statistical significance were found regarding the endpoints of TIMI Ⅲ （73.7% in TA group and 60. 7% in control group, P =0. 11 ）, MBG m （49. 1% in TA grout and 47.2% in control group, P = 0. 82） immediately after the procedure. Complete STR was achieved in 47. 4% of patients in TA group and 41.6% of patients in control group at 90 minutes after the procedure （P = 0.49） . MACE-free survival at 30 d clinical follow-up was similar （ 93.0% in TA group and 89. 9% in control group, log-rank P = 0. 51 ） . Conclusions The current retrospective analysis indicated that TA exerted no beneficial effects in improving myocardial perfusion or 30 d clinical outcomes in STEMI patients underwent primary PCI with stent implantation and PSBD. Further methods to improve myocardial perfusion or prevent no-/slow-flow after PSBD are still under investigation in real world nractice.