血栓抽吸及替罗非班联合治疗急性ST段抬高型心肌梗死PCI术中无复流现象的疗效

Effect of Thrombus Aspiration Combined with Tirofiban on No-Reflow Phenomenon in Patients with ST-Elevation Myocardial Infarction during PCI

目的观察血栓抽吸与替罗非班联合应用治疗急性心肌梗死患者行急诊经皮冠状动脉介入术(PCI)时出现无复流的临床疗效。方法将66例行急诊造影术后提示冠状动脉无复流的急性心肌梗死患者按随机数字表法分为观察组(n=33)及对照组(n=33)。对照组在急诊PCI时单纯给予静脉注射替罗非班,观察组在PCI时行血栓抽吸并通过血栓抽吸导管注射替罗非班。比较2组术后血流TIMI改善率、ST段回落率、肌钙蛋白(cTnT)和肌酸激酶同工酶(CKMB)的峰值,术后1周及术后6个月的左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及术后6个月内主要心血管不良事件(MACE)(心绞痛发作、再发心肌梗死、心力衰竭、心源性猝死、再次血运重建、死亡、负荷心脏事件)的发生率。结果观察组及对照组术后TIMI血流分级(0级、1级、2级、3级)分别为6.1%、33.3%、48.5%、12.1%及45.5%、42.4%、9.1%、3.0%(P<0.05)。观察组CKMB、cTnT峰值、6个月后LVEDD及MACE分别为(112.06±14.06)U·L-1、(57.82±15.81)ng·mL-1、(54.24±4.46)mm及15.2%,对照组分别为(140.67±27.4)U·L-1、(71.42±13.55)ng·mL-1、(57.94±2.90)mm及84.8%,观察组均明显低于对照组(均P<0.05)。2组ST段回落率,1周后LVEDD、LVEF及6个月后LVEF比较差异均无统计学意义(均P>0.05)。结论急性心肌梗死行急诊造影术后提示冠状动脉无复流的患者,在PCI时行血栓抽吸并通过血栓抽吸导管注射替罗非班,能明显改善患者术后TIMI血流,降低CKMB、cTnT峰值及MACE的发生,明显改善患者预后。

Objective To investigate the clinical effect of thrombus aspiration combined tirofi-ban on no-reflow phenomenon in patients with ST-elevation myocardial infarction(STEMI)dur-ing percutaneous coronary intervention(PCI).Methods A total of 66 acute myocardial infarction patients with angiographic no-reflow phenomenon were randomly divided into two groups,with 33 patients in each group.The control group was given intravenous injection of tirofiban during PCI. The observation group was simultaneously given thrombus aspiration and tirofiban injection dur-ing PCI.The improvement in thrombolysis in myocardial infarction(TIMI)flow,ST segment de-pression and peak cardiac troponin T(cTnT)and creatine kinase MB(CKMB)levels were com-pared between the two groups after PCI.In addition,left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)were determined 1 week and 6 months after PCI. The incidence of major adverse cardiovascular events(MACE,including angina,reinfarction,heart failure,sudden cardiac death,vessel revascularization,death and load events)was recorded within 6 months after PCI.Results The incidences of postoperative TIMI grades 0,1,2 and 3 flow were, respectively,6.1%,33.3%,48.5% and 12.1% in observation group,and 45.5%,42.4%,9.1%and 3.0% in control group (P < 0.05).The peak CKMB and cTnT levels were,respectively, (112.06±14.06)U· L-1 and(57.82 ± 15.81)ng·mL-1 in observation group,and(140.67 ± 27.4)U·L-1 and(71.42±13.55)ng·mL-1 in control group(P <0.05).The LVEDD and inci-dence of MACE were,respectively,(54.24 ± 4.46)mm and 15.2% in observation group,and (57.94±2.90)mm and 84.8% in control group(P <0.05).There were no significant differences between the two groups in ST segment depression rate,as well as in LVEDD 1 week after PCI, and in LVEF 1 week and 6 months after PCI(P >0.05).Conclusion Thrombus aspiration com-bined tirofiban injection during PCI can ameliorate TIMI flow,decrease peak CKMB and cTnT levels,reduce MACE and improve prognosis in acute myocardial infarction patients with angio-graphic no-reflow phenomenon.