拘禁球囊技术在AMI患者急诊介入处理分叉病变术中的安全性及对近中期预后影响

Safety and influence on short-term and mid-term prognosis of jailed balloon technique in treatment of bifurcation lesions with emergency percutaneous coronary intervention in patients with acute myocardial infarction

目的通过观察拘禁球囊技术在急性心肌梗死(AMI)患者急诊介入治疗中的分支血管保护的安全性及近、中期临床疗效,为AMI分叉病变的处理及治疗提供更为简单有效的策略和临床理论依据。方法回顾性收集2016年1月至2018年6月间于北京大学民航总医院诊断为AMI分叉病变且接受急诊经皮冠状动脉介入治疗(PCI)的87例患者,将其分为观察组(n=39,拘禁球囊技术)和对照组(n=48,常规拘禁导丝技术)。观察:①主支支架后,分支有无闭塞或夹层,主支发生无复流情况和分支最终的冠状动脉(冠脉)血流TIMI分级;②住院期间和PCI后12个月内随访主要不良心脑血管事件(MACCE)和主支血管再狭窄情况。结果对照组中9例发生边支闭塞或次全闭塞,2例最终处理失败,术中3例主支发生无复流;观察组中2例发生边支闭塞或次全闭塞,优于对照组(5.1%vs.18.8%,P=0.115),均成功完成处理,术中2例患者主支发生无复流,分支TIMI3级获得率明显高于对照组(97.4%vs.87.5%,P=0.511)。住院期间和术后12个月的随访,观察组中MACCE事件发生率低于对照组(12.8%vs.25%,P=0.154),术后冠脉造影复查,两组患者主支血管均未发生再狭窄。结论AMI患者的真分叉病变,使用拘禁球囊技术是安全的,与传统边支保护技术比较,可获得更优的即刻及近、中期预后趋势。

Objective To provide a more simple and effective strategy and clinical theoretical basis for the management and treatment of bifurcation lesions in patients with acute myocardial infarction(AMI)undergone emergency percutaneous coronary intervention(PCI)through observing the safety and short-term and mid-term clinical efficacy of jailed balloon technique(JBT)in branch vessel protection.Methods The patients with AMI bifurcation lesions undergone emergency PCI(n=87)were retrospectively chosen from Civil Aviation General Hospital affiliated to Peking University from Jan.2016 to June 2018,and then divided into observation group(n=39,JBT)and control group(n=48,routine jailed wire technique).Observation:①occlusion or dissection after stent implantation in the main branch,occurrence of main branch no-reflow,and the final TIMI flow grades(TFGS)of coronary branches;②incidence of major adverse cardiovascular and cerebrovascular events(MACCE)and primary vessel restenosis during hospitalization and follow-up for 12 months after PCI.Results In control group,9 cases had side branch occlusion or subtotal occlusion,2 cases failed in the final treatment,and 3 cases had no-reflow of the main branch during operation,and in observation group,2 cases had side branch occlusion or subtotal occlusion(5.1%vs.18.8%,P=0.115),and all cases had successful treatment.There were 2 patients with no-reflow of the main branch during operation in observation group,and acquisition rate of branch TIMI3 was significantly higher in observation group than that in control group(97.4%vs.87.5%,P=0.511).The incidence rate of MACCE was lower in observation group than that in control group(12.8%vs.25%,P=0.154)during hospitalization and follow-up for 12 months.The results of postoperative coronary angiography reexamination showed that there was no restenosis occurred in the main vessels in 2 groups.Conclusion It is safe to use JBT for true bifurcation lesions in AMI patients.Compared with traditional side branch protection technique,JBT can obtain better immediate and shortterm and mid-term prognosis.