血栓抽吸后行直接冠状动脉支架置入术对急性ST段抬高心肌梗死患者的疗效观察

Effectiveness in thrombus aspiration followed by direct coronary stent implantation in patient with ST-segment elevation myocardial infarction

目的评估血栓抽吸(TA)后行直接冠状动脉支架置入术对ST段抬高心肌梗死(STEMI)患者预后的影响。方法纳入2011年12月至2014年7月因STEMI入院且发病在12 h内并行直接冠状动脉支架置入术、符合入选标准的患者443例,其中TA后直接置入支架患者113例(TA组),TA后球囊预扩张(BP)患者330例(TA+BP组)。主要终点:12个月主要不良心血管事件(MACE)的发生情况;次要终点:靶血管远段栓塞和支架内血栓形成。结果所有患者均成功置入支架。TA组患者术后60 min内ST段回落>50%的比例(69.0%比51.8%,P=0.001)显著大于TA+BP组,差异有统计学意义。TA组TIMI血流≥Ⅱ级在TA后即刻(76.1%比65.8%,P=0.043)、支架置入前/BP后(76.1%比62.4%,P=0.012)、支架置入后(92.0%比84.5%,P=0.042)及手术结束前(95.6%比91.2%,P=0.033)比例显著大于TA+BP组,差异均有统计学意义;而术中因TIMI血流欠佳或血栓负荷仍较重而补救性使用血小板糖蛋白Ⅱb/Ⅲa抑制药的比例(16.8%比27.6%,P=0.026)及靶血管远段栓塞的比例(6.2%比13.3%,P=0.040)显著低于TA+BP组,差异亦均有统计学意义。虽然两组患者在住院期间和随访12个月的MACE发生率比较差异无统计学意义,但TA组患者总MACE发生率(5.3%比11.8%,P=0.041)显著低于TA+BP组,差异有统计学意义。结论TA后行直接冠状动脉支架置入术可改善STEMI患者最终的心肌再灌注,从而改善患者短期临床预后。

Objective Compared with routine balloon predilatation（ BP） in ST-elevation myocardial infarction（ STEMI） patients,the aim of the present study was to assess impact of selective thrombus aspiration（ TA） followed by direct coronary stent implantation. Methods Between Dec 2011 and Jul 2014,a total of 443 patients（ 113 patients in TA group and 330 patients in TA ＋ BP group） who were eligible for the observation criteria,admitted with STEMI（ within 12 h from symptoms onset） and candidates for direct coronary stent implantation were enrolled. The major indexes of this study were the 12 month major adverse cardiac events（ MACE）. Secondary indexes included distal embolizations of infarct-related artery and stent thrombosis. Results Procedural success was obtained in all patients. The rate of 60 min STsegment resolution 50% was significantly higher in the TA group than in the TA ＋ BP group（ 69. 0% vs.51. 8%,P = 0. 001）. The rates of TIMI grade Ⅱ or Ⅲ flow following stent implantation and befor the end of the operation were significantly higher among patients in TA group compared with TA ＋ BP group,respectively（ 92. 0% vs. 84. 5%,95. 6% vs. 91. 2%,all P 0. 05）. The rate of evident distal embolizations in patietnts of TA group was significantly lower than that in TA ＋ BP group（ 6. 2% vs.13. 3%,P = 0. 040）. There was no difference among the groups in in-hospital or 12-month MACE,respectively（ 1. 8% vs. 2. 1%,3. 5% vs. 9. 1%,all P 0. 05）. But total MACE was significantly disease in the TA group compared with the TA ＋ BP group（ 5. 3% vs. 11. 8%, P = 0. 041）.Conclusions Compared with conventional primary PCI,selective TA and direct stenting procedure may improve final myocardial reperfusion and the one-year outcomes for STEMI patients.