高血栓负荷伴弥漫性病变的STEMI患者延期支架植入术的效果观察

Effect of deferred stent implantation for STEMI patients with high thrombus burden and diffuse lesion

目的观察延期支架植入对高血栓负荷合并弥漫性病变的ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的效果。方法选取冠状动脉造影显示血栓负荷重度且梗死相关动脉(infarct related artery,IRA)为弥漫性病变,经初步介入操作,IRA恢复TIMI血流3级后的STEMI患者96例,随机分为即刻组47例和延期组46例。即刻组完成后续放支架操作,延期组于1周后完成放支架治疗。比较2组支架植入后无复流/慢血流概率、人均支架数、平均支架长度、平均住院时间及平均住院费用。6个月时比较主要不良心脏事件(major adverse cardiovascular events,MACE)发生率及超声指标:左心室射血分数(left ventricular ejection fraction,LVEF)及左心室舒张末内径(left ventricular end diastolic diameter,LVD)。结果延期组慢血流/无复流发生率显著低于即刻组,人均支架植入数和平均支架长度小于即刻组,无支架植入比例高于即刻组(P<0.05)。6个月后,2组LVEF明显高于发病时,LVD明显低于发病时,延期组LVEF明显低于即刻组,LVD明显高于即刻组(P<0.05)。延期组首次住院时间长于即刻组,首次住院费用和再住院率低于即刻组(P<0.05),2组心源性死亡、支架后靶血管再次血运重建(target vessel revascularization,TVR)差异均无统计学意义(P>0.05)。延期组累积无MACE生存率显著高于即刻组(P<0.05)。结论对于高血栓负荷合并弥漫性病变的STEMI患者,延期支架植入能减少无复流/慢血流发生率,减少支架植入数量,改善6个月时心功能及心室重构,减少6个月内再住院率,降低医疗费用。

Objective To observe the effect of deferred stent implantation in acute ST-segment elevation myocardial infarction(STEMI)patients with high thrombus burden and diffuse lesion.Methods The 96 STEMI patients were selected for coronary angiography to show severe thrombus load and diffuse lesions of infarct related artery(IRA).After initial intervention,the thrombolysis in myocardial infarction(TIMI)blood flow grade 3 of the infarct related artery(IRA)was restored,but the lesions were diffuse.They were randomly divided into immediate group(n=47)and deferred group(n=46).The immediate group received the follow-up stent implantation,and the deferred group received stent implantation 1 week later.The incidence of no re-flow/slow flow,the average number of stents per capita,the average length of the stents,the average length of stay and the mean hospitalized cost were compared between two groups.Left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVD)and major adverse cardiovascular events(MACE)were compared at 6 months.Results The incidence of no re-flow/slow flow in deferred group was significantly lower than that in immediate group,the number of stent implantation per capita and the average stent length were lower than those in immediate group,and the proportion of stent free implantation was higher than that in immediate group(P<0.05).After 6 months,compared with the admission,LVEF and LVD of the two groups were significantly higher and lower(P<0.05).At 6 months,compared with the immediate group,the deferred group had higher LVEF and lower LVD(P<0.05).The average length of stay in the deferred group was longer than that in the immediate group,and the average cost of stay was less(P<0.05).After 6 months follow-up,there was no significant difference in cardiovascular death and target vessel revascularization(TVR)between two groups(P>0.05).The cumulative MACE free survival rate in deferred group was significantly higher than that in immediate group(P<0.05).Conclusion For STEMI patients with high thrombus burden and diffuse lesion,deferred stent implantation can reduce the incidence of no-reflow/slow flow,reduce the number of stent implantation,improve cardiac function and ventricular remodeling at 6 months,reduce the readmission rate within 6 months,and reduce medical costs.