延迟支架置入在高血栓负荷急性STEMI老年患者中的临床分析

Clinical Analysis of Deferred Stent Implantation in Elderly Patients with High Thrombus Burden of Acute ST-segment Elevation Myocardial Infarction

探讨延迟支架置入在高血栓负荷急性ST段抬高型心肌梗死(STEMI)老年患者中的临床应用价值。选取笔者所在医院发病12h内的老年高血栓负荷STEMI患者81例,罪犯血管行血栓抽吸后前向血流达TIMI 2级~3级且血栓积分≤2分的患者随机分为常规治疗组(33例)和延迟治疗组(28例)。比较两组患者术后慢血流/无复流发生率、心肌灌注呈色分级、术后6月心功能及术后6月内复合终点事件发生率。延迟组支架置入后慢血流/无复流发生率显著低于常规治疗组(P<0.05),心肌呈色分级、术后6个月LVEF改善幅度明显高于常规组(P<0.05),左心室舒张末期内径明显低于常规组(P<0.05),6个月内复合终点事件发生率延迟组高于常规组,差异无统计学意义(P>0.05)。血栓抽吸后延迟支架置入可显著减少老年高血栓负荷急性STEMI患者慢血流/无复流发生率,提高心肌灌注,改善老年患者心功能。

To investigate the clinical value of deferred stent implantation in elderly patients with high thrombus burden of acute ST-segment elevation myocardial infarction （STEMI）.The authors selected 81 cases with a high thrombus burden within 12 hours of onset in elderly patients with STEMI, after the thrombus aspiration,when the antegrade flow reach of TIMI 2~3 and thrombus score （TS）≤2 points in culprit coronary artery, then the elderly patients were randomly divided into conventional stenting group （n=33） and deferred stenting group （n=28）.Two groups of elderly patients were compared with the incidence of slow-/no-reflow,myocardial blush grade（MBG）, the incidence of compound endpoints in six months and the cardiac function after PCI for six months.After stenting, the incidence of slow-/no-reflow in deferred stenting group was significantly lower than that in the conventional stenting group （P〈0.05）;the MBG of deferred stenting group was significantly higher than that of conventional stenting group （P〈0.05）.After PCI for six months, the improvement of LVEF in the deferred stenting group was significantly higher than that in the conventional stenting group（P〈0.05）;the left ventricular end diastolic dimension （LVEDD） in deferred stenting group was significantly lower than that in conventional stenting group （P〈0.05）;the compound endpoints events within six months in deferred stenting group was higher than that in the conventional stenting group,the difference was not statistically significant （P〉0.05）.After thrombus aspiration of elderly patients with high thrombus burden of acute STEMI, deferred stent implantation can significantly reduce the rate of slow-/no-reflow, improve myocardial perfusion and improve cardiac function in elderly patients.