血栓抽吸对急性STEMI患者PCI术后组织突出的影响

Effect of thrombus aspiration on protrusion of tissue in patients with acute STEMI after percutaneous coronary intervention

目的探讨血栓抽吸对ST段抬高型心肌梗死(STEMI)患者PCI术后组织突出的影响。方法选择2014-02至2017-08接受直接PCI并行OCT检查的106例STEMI患者,包含血栓抽吸-PCI组(n=69)和标准PCI组(n=37)。在直接PCI术后立即进行OCT评估,以评估支架段的病变形态。结果血栓抽吸-PCI组与标准PCI组最小支架面积相似[7.3(IQR:5.8~8.5)vs 7.3(IQR:6.0~8.7)mm2,P=0.818]。最大组织突出面积[0.6(IQR:0.2~1.1)vs 1.2(IQR:0.8~1.6)mm2,P<0.001],平均组织突出面积[0.1(IQR:0.1~0.2)vs 0.4(IQR:0.2~0.7)mm2,P<0.001],与标准PCI组相比,血栓抽吸-PCI组上述值明显较小。与标准PCI组相比,血栓抽吸-PCI组的最小管腔面积明显更大[7.1(IQR:6.2~8.0)vs 5.9(IQR:4.9~6.8)mm2,P<0.01]。结论与标准PCI组相比,STEMI患者行血管成形术前血栓抽吸组的组织突出面积明显减小,管腔面积较大。直接PCI术中的血栓抽吸有利于影响支架区段的病变形态,因此可作为直接PCI术中一种有效的辅助治疗。

Objective To assess the effect of thrombus aspiration by optical coherence tomography（ OCT） before angioplasty on poststenting tissue protrusion in patients undergoing a primary percutaneous coronary intervention（ PCI） for ST-elevation myocardial infarction（ STEMI）. Methods A total of 106 patients with STEMI who had undergone primary PCI with concurrent OCT were examined in this study,including 69 recipients of thrombus aspiration-PCI and 37 recipients of standard PCI. OCT was performed immediately after primary PCI to assess lesion morphology in the stented segment. Results The minimum stent area was similar between the thrombus aspiration-PCI group and the standard PCI group [7. 3（ IQR： 5. 8-8. 5） vs 7. 3（ IQR： 6. 0-8. 7） mm-2,P = 0. 818]. The maximum tissue protrusion area was[0. 6（ IQR： 0. 2-1. 1） vs 1. 2（ IQR： 0. 8-1. 6） mm-2,P〈0. 001],while the mean tissue protrusion area was[0. 1（ IQR： 0. 1-0. 2） vs 0. 4（ IQR： 0. 2-0. 7） mm2,P〈0. 001],both of which were significantly smaller in the thrombus aspiration-PCI group than in the standard PCI group. The minimum lumen area was significantly greater in the thrombus aspiration-PCI group than in the standard PCI group [7. 1（ IQR： 6. 2-8. 0 vs 5. 9（ IQR： 4. 9-6. 8） mm-2,P〈0. 01].Conclusions Thrombus aspiration before angioplasty in patients with STEMI is associated with significantly smaller tissue protrusion areas and larger lumen poststenting areas than standard PCI. Thrombus aspiration in the primary PCI group favors the lesion morphology in the stent segment and therefore may be a useful adjuvant therapy for primary PCI.