早期肝素化对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的疗效

Effects of early heparin therapy on patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的探究直接经皮冠状动脉介入术前(primary percutaneous coronary intervention,pPCI)肝素化对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的影响。方法连续入选STEMI患者117例,随机分为观察组和对照组,观察组确诊为STEMI后立即静脉注射普通肝素5000 U,对照组于术中给予普通肝素5000 U。观察肝素启动时间、PCI前活化的凝血时间(activated coagulation time,ACT)、心肌损伤标志物峰值、心肌微循环阻力指数(index of microcirculation resistance,IMR)、其他心肌灌注评估指标。记录术后主要不良事件(major adverse events,MAES)。结果与对照组比较,观察组肝素给予的时间明显提前(约28 min),术前ACT明显延长(P=0.000),血栓负荷率低(25.00%vs 43.90%,P=0.032);造影即刻梗死相关动脉(IRA)的TIMI血流0~1级率低(45.00%vs 68.40%,P=0.011),TIMI心肌灌注分级(TMPG)3级率高(75.30%vs 56.10%,P=0.032),IMR较低(P=0.007),心肌损伤标志物CK-MB峰值低(P=0.007),心肌灌注缺损面积(perfusion defect area,PDA)较低(P=0.031)。结论pPCI术前早期肝素化提高了IRA的开通率,缩短心肌总缺血时间,缩小心肌梗死面积,改善心肌灌注,不增加MAES的风险。

Objective To determine the effects of heparin therapy before primary percutaneous coronary intervention(pPCI)on patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 117 STEMI patients were consecutively enrolled and randomly divided into observation group and control group.The STEMI patients of observation group were immediately given intravenous injection of 5000 U unfractionated heparin,while those in control group received the same dose of unfractionated heparin during the surgery.The activation time of heparin,activated coagulation time(ACT)before PCI,peak value of myocardial injury markers,index of microcirculation resistance(IMR)of myocardia,and other evaluation indexes of myocardial perfusion were observed.Major adverse events(MAES)after the operation were also recorded.Results Compared with the control group,observation group had significantly earlier administration of heparin(about 28 min),longer ACT(P=0.000),and lower rate of high thrombus load(25.00%vs 43.90%,P=0.032);imaging-ready infarct related artery(IRA)TIMI flow rate 0-1 lower(45.00%vs 68.40%,P=0.011),higher rate of TIMI myocardial perfusion grading(TMPG)3(75.30%vs 56.10%,P=0.032),lower IMR(P=0.007)lower peak value of CK-MB(P=0.007),and smaller perfusion defect area(PDA)(P=0.031).Conclusion Early heparin therapy before pPCI can improve IRA opening,reduce total myocardial ischemia time,and myocardial infarction area,and ameliorate myocardial perfusion.And it does not increase the risk of MAES.