急性心肌梗死患者经靶向灌注导管行梗死相关血管远端逆向用药球囊预扩张对冠状动脉血流的影响

Effects of pre-dilation by infarct-related artery's distal end reverse drug on coronary blood flow via targeted perfusion catheter in patients with acute myocardial infarction

目的探讨急性ST段抬高心肌梗死患者急诊直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)应用靶向灌注导管行梗死相关血管(infarct-related artery,IRA)逆向用药防治冠状动脉慢/无复流研究中小球囊低压力预扩张对其疗效的影响。方法回顾性分析46例急性ST段抬高心肌梗死患者在直接PCI前均应用靶向灌注导管行IRA靶病变远端逆向注射血小板糖蛋白Ⅱb/Ⅲa抑制剂替罗非班、硝酸甘油,根据在IRA逆向用药前靶病变处是否行球囊预扩张分为预扩张组(21例)和未行预扩张组(25例),比较两组的临床资料、术中慢/无复流现象发生率,并观察住院期间主要心血管事件。结果预扩张组患者慢/无复流的发生率9.5%,主要心脏事件发生率9.5%;未行预扩张组患者慢/无复流发生率8%,主要心脏事件发生率12%。结论两组患者慢/无复流和不良心血管事件发生率无明显差别,急性ST段抬高心肌梗死患者经靶向灌注导管行IRA远端逆向用药前IRA靶病变处小球囊低压力预扩张不增加慢/无复流的发生,不影响直接PCI治疗结果。

Objective To investigate the effects of small-balloon low-pressure pre-dilation in study of infarct-related artery＇s（ IRA） reverse drug in prevention of slow / no-reflow phenomenon via targeted perfusion catheter before directly emergent percutaneous coronary intervention（ PCI） in patients with acute ST-segment elevation myocardial infarction（ STEMI）. Method Retrospective analysis was carried out for reverse injection of platelet glycoproteinⅡb /Ⅲa inhibitors tirofiban and nitroglycerin at IRA distal end targeted lesion by using targeted perfusion catheter before direct PCI in 46 patients with STEMI. Those patients were divided into pre-dilation group（ 21 cases） and non-predilation group（ 25 cases） based on whether the balloon was pre-dilated at targeted lesion before IRA reverse drug. The clinical data and incidence of intra-operative slow / no-reflow were compared between two groups and the major adverse cardiac events（ MACE） were investigated during the hospital stay. Result The incidence of slow / no-reflow is 9. 5 % and 12 % for incidence of MACE in the pre-dilation group while the incidence of slow / no-reflow is 8 % and12% for incidence of MACE in the non-predilation group. Conclusion The difference of incidence of slow / no-reflow and MACE is not significant. Therefore,the small-balloon low-pressure pre-dilation won＇t increase the slow / no-reflow phenomenon at IRA targeted lesion before performing the IRA distal end reverse drug via targeted perfusion catheter in patients with STEMI and won＇t affect the treatment outcomes of direct PCI.