急性前壁ST段抬高型心肌梗死血栓抽吸后临界病变是否即刻植入支架预后研究

Prognosis of whether stent should be implanted immediately in borderline lesion of acute anterior ST-segment elevation myocardial infarction after thrombus aspiration

目的研究急性前壁ST段抬高型心肌梗死(AASTEMI)患者血栓抽吸后罪犯冠状动脉血管残余狭窄50%~70%病变(临界病变)植入支架的效果。方法连续入选2014年1月至2018年1月接受直接PCI的AASTEMI患者,血栓抽吸恢复TIMI 3级血流后临界病变119例,随机分单纯血栓抽吸组(单纯组,62例)及血栓抽吸联合支架治疗组(联合组,57例)。观察术后心肌灌注Blush分级(MBG)、术后心肌梗死溶栓试验(TIMI)血流分级、总ST段回落及12个月随访左心室舒张末内径、左心室射血分数(LVEF)、血清B型利钠肽前体(pro-BNP)、再发心肌梗死、靶血管再次血运重建术及死亡情况。结果单纯组TIMI血流分级、MBG分级优于联合组,慢血流和无复流发生率低于联合组,12个月随访联合组再发心肌梗死率、靶血管再次血运重建术率、死亡率略高于单纯组,但差异无统计学意义(P>0.05)。结论 AASTEMI血栓抽吸恢复有效心肌灌注血流但存在残余临界病变患者,即刻行冠状动脉支架植入术可能影响心肌再灌注,并导致心血管不良事件增加、心功能恶化,宜慎重选择。

Objective To investigate the effect of stent implantation for 50%-70% residual coronary stenosis(borderline lesion) in culprit vessels with acute anterior ST-segment elevation myocardial infarction(AASTEMI) after thrombus aspiration.Methods A total of 119 AASTEMI patients with borderline lesion after thrombus aspiration for recovery of TIMI grade 3 were selected and divided into thrombus aspiration group(simple group,n=62) and thrombus aspiration combined with stent group(combined group,n=57) randomly.Postoperative myocardial Blush grade(MBG),postoperative thrombolysis in myocardial infarction(TIMI) trial flow grade, total ST-segment resolution,and 12-month follow-up of left ventricular end-diastolic diameter,left ventricular ejection fraction(EF%),serum B-type natriuretic peptide precurson(pro-BNP),recurrent myocardial infarction,target vessel revascularization and death were observed.Results The TIMI blood flow grading,MBG grading in simple group were better,the incidences of slow blood flow and no-flow were lower than those in combined group(P<0.01).The incidence of recurrent myocardial infarction,target vessel revascularization and death in combined group was higher than those in simple group at 12-month follow-up,but there were no significant difference between two groups(P>0.05).Conclusions For the patients with AASTEMI thrombus aspiration to restore effective myocardial perfusion blood flow but have residual critical lesions, immediate coronary stent implantation may affect myocardial reperfusion and lead to the increase of cardiovascular adverse events and deterioration of cardiac function,which should be carefully selected.