用Rebirth抽吸导管对STEMI高血栓负荷患者再灌注心律失常的影响

Influence of Rebirth aspiration catheter on reperfusion arrhythmia in STEMI patients with high thrombus burden

目的:研究经皮冠脉介入治疗(PCI)术中使用Rebirth抽吸导管对ST段抬高型心肌梗死(STEMI)高血栓负荷患者再灌注心律失常(RA)的影响。方法:入选因STEMI于我院行急诊PCI且梗死相关动脉闭塞特征为高血栓负荷的患者,随机分为直接血栓抽吸组(60例)和常规球囊预扩组(60例)。观察两组PCI术中RA的发生情况和血栓脱落情况、术后即刻血流TIMI分级等。随访术后1个月内主要不良心血管事件(MACE)。结果:与常规球囊预扩组比较,直接血栓抽吸组RA持续时间[(7.24±2.00)min比(5.03±2.41)min]、RA引起血流动力学改变相关临床症状比例(75.61%比52.63%)均显著减少(P依次=0.001、0.033)。两组术中血栓脱落、术后即刻TIMI分级、术后ST段回落率和RA发生率均无显著差异(P均>0.05)。术后1个月随访,两组MACE发生率无显著差异(P=0.564)。结论:对STEMI高血栓负荷患者PCI术中使用血栓抽吸策略不降低再灌注心律失常的发生率,但可以缩短再灌注心律失常持续的时间,减少临床症状。

Objective:To study influence of application of Rebirth aspiration catheter during percutaneous coronary intervention(PCI)on reperfusion arrhythmia(RA)in patients with ST segment elevation myocardial infarction(STEMI)and high thrombus burden.Methods:A total of 120 patients,who received emergency PCI in our hospital due to STEMI and infarct related artery occlusion feature is high thrombus burden,were randomly divided into direct thrombus aspiration group(n=60)and routine balloon predilation group(n=60).Incidence of RA during PCI,thrombus shedding and blood flow TIMI grade instant after PCI etc.were observed and compared between two groups.Incidence rate of major adverse cardiovascular events(MACE)within one month after PCI was followed up in two groups.Results:Compared with routine balloon predilation group,there were significant reductions in RA duration[(7.24±2.00)min vs.(5.03±2.41)min]and percentage of hemodynamic change related clinical symptoms caused by RA(75.61%vs.52.63%)in direct thrombus aspiration group,P=0.001,0.033 in turn.There were no significant difference in percentages of thrombus shedding during PCI,TIMI grade instant after PCI,postoperative ST segment regression rate and incidence rate of RA between two groups,P>0.05 all.There was no significant difference in incidence rate of MACE within one-month follow-up after PCI between two groups,P=0.564.Conclusion:Thrombus aspiration strategy doesn’t reduce incidence rate of RA in STEMI patients with high thrombus burden during PCI,but it can shorten RA duration and reduce clinical symptoms.