血栓抽吸对急性ST段抬高型心肌梗死合并心力衰竭直接PCI治疗患者的临床疗效

Clinical efficacy of thrombus aspiration in patients with acute ST-segment elevation myocardial infarction with pump failure after primary PCI

目的 评价血栓抽吸对急性ST段抬高型心肌梗死合并心力衰竭直接PCI（percutaneous coronary intervention,PCI）治疗患者的临床疗效。方法 纳入2013年3月至2014年12月湛江中心人民医院心内科收治的急性ST段抬高型心肌梗死合并心力衰竭患者110例,其中男68例,女42例,年龄51~89岁。按随机表法把患者随机纳入对照组或血栓抽吸组,每组各55例。对照组接受PCI治疗加常规药物治疗,血栓抽吸组接受血栓抽吸、PCI治疗和常规药物治疗。比较两组患者的一般临床资料、PCI治疗后即刻效果[心肌梗死溶栓（thrombolysis in myocardial infarction,TIMI）血流3级的比例,校正TIMI的帧数、ST抬高回落百分比、肌钙蛋白I和肌酸激酶及同工酶（CK-MB）的数值]、PCI治疗后1 d和术后6个月的心功能[左心室射血分数（left ventricular ejection fraction,LVEF）、左心室收缩末期内径（left ventricular end-systolic dimension,LVESD）、左心室舒张末期内径（left ventricular end-diastolic dimension,LVEDD）]以及PCI治疗后6个月主要心血管事件（major adverse cardiovascular event,MACE）的发生率。结果 对照组和血栓抽吸组在年龄、性别构成、吸烟、原发性高血压、帕金森病史、2型糖尿病、发病至PCI治疗时间、病变血管、心肌梗死部位、梗死相关动脉以及术前TIMI血流情况等比较,差异无统计学意义（P〉0.05）。血栓抽吸组和对照组比较,前者PCI治疗后TIMI血流3级患者的比例较高、校正TIMI帧数较低、ST抬高回落百分比〉70%的比例较高、肌钙蛋白I和肌酸激酶及同工酶（CK-MB）较低,差异有统计学意义（P〈0.05）。PCI治疗后1 d,两组的LVEF、LVESD和LVEDD比较,差异无统计学意义（P〉0.05）。PCI治疗后6个月与术后1 d比较,对照组的LVEF显著升高,LVEDD显著降低;血栓抽吸组的LVEF也显著升高,LVESD和LVEDD均显著下降,差异有统计学意义（P〈0.05）。PCI治疗后6个月,血栓抽吸组与对照组比较,前者的LVEF较高,LVESD和LVEDD较低,差异有统计学意义（P〈0.05）。术后随访6个月内,血栓抽吸组MACE事件5例（发生率9.1%）,对照组3例（发生率5.5%）,差异无统计学意义（P〉0.05）。结论 血栓抽吸能改善急性ST段抬高型心肌梗死合并心力衰竭直接PCI治疗患者的心肌再灌注情况和心功能,并且不增加MACE的发生率,临床疗效值得肯定。

Objectives To evaluate the clinical efficacy of thrombus aspiration in patients with acute ST-segment elevation myocardial infarction with pump failure after primary percutaneous coronary intervention（PCI）. Methods A total of 110 patients with acute ST-segment elevation myocardial infarction with pump failure were included between March 2013 and December 2014 in Central People＇s Hospital of Zhanjiang, of which, 68 were male and 42 were female, aged between 51- 89 years old. They were randomized into control group and thrombus aspiration group,55 cases for each. Patients in control group received PCI ＋ conventional medication, while patients in thrombus aspiration group received thrombus aspiration ＋ PCI ＋ conventional medication. The following data of the two groups were compared： baseline data, immediate post-PCI results [proportion of thrombolysis in myocardial infarction（TIMI） 3level, corrected TIMI frame count, ST-elevation depression, troponin I and creatine kinase-isoenzyme（CK-MB）],cardiac functions 1 day and 6 months after PCI [left ventricular ejection fraction（LVEF）, left ventricular end-systolic diameter（LVESD） and left ventricular end-diastolic diameter（LVEDD） ] and incidence of major adverse cardiovascular events（MACE） 6 months after PCI. Results There were no differences between the two groups in age,gender, smoking, hypertension, Parkinson ＇s disease, type 2 diabetes, the time from onset to PCI, criminal coronary artery, myocardial infarction area, infarct-related artery and TIMI flow pre-PCI（P〉0.05）. Compared with control group, thrombus aspiration group had a higher proportion of TIMI 3 lever, a lower corrected TIMI frame count, a higher proportion of ST-elevation depression 70%, lower values of troponin I and CK-MB（P〈0.05）. One day after PCI, there were no differences between the two groups in LVEF, LVESD and LVEDD（P〉0.05）. Six months after PCI,LVEF increased significantly and LVEDD decreased significantly in control group,while LVEF increased significantly and both LVESD and LVEDD decreased significantly in thrombus aspiration group（P〈0.05）. Thrombus aspiration group had a higher LVEF, lower LVESD and LVEDD compared with control group 6 months after PCI（ P〈0. 05）. In the 6-month post-PCI follow-up, there were 5 cases（9.1%） of MACE in thrombus aspiration group and 3 cases（5.5%） in control group. The difference was not statistically significant（P〉0.05）. Conclusions Thrombus aspiration can improve myocardial perfusion and cardiac function in patients with acute ST-segment elevation myocardial infarction with pump failure after primary PCI without increasing the incidence of MACE.