急诊PCI术中血栓抽吸联合尿激酶原治疗高血栓负荷STEMI的临床研究

Effect of Thrombus Aspiration Combined with Prourokinase in the Treatment of ST-segment Elevation Myocardial Infraction Patients with High Thrombus Burden during Primary Percutaneous Coronary Intervention

目的探讨急诊冠状动脉介入治疗(PCI)术中血栓抽吸联合尿激酶原治疗高血栓负荷ST段抬高型心肌梗死(STEMI)的安全性及有效性。方法采用回顾性研究方法,纳入2017年2月—2019年2月于河北省人民医院行急诊PCI且术中应用血栓抽吸的高血栓负荷STEMI病人175例。依据术中是否应用尿激酶原冠状动脉溶栓分为血栓抽吸组(111例)和血栓抽吸联合尿激酶原组(64例)。收集病人基线临床资料和急诊PCI术资料,并记录院内及术后12个月内主要不良心脑血管事件(MACCE)和出血事件发生情况。结果血栓抽吸联合尿激酶原组年龄小于血栓抽吸组(P<0.05)。血栓抽吸联合尿激酶原组术后慢血流/无复流发生率低于血栓抽吸组(12.5%与25.2%,P<0.05)。血栓抽吸联合尿激酶原组院内及术后12个月心源性死亡发生率低于血栓抽吸组(P<0.05)。两组病人院内及术后12个月内心力衰竭、靶血管重建、再发心肌梗死、新发缺血性卒中及出血事件发生率比较差异均无统计学意义(P>0.05)。Kaplan-Meier分析显示,术后12个月,两组无MACCE生存率比较差异无统计学意义(P=0.206)。结论血栓抽吸联合尿激酶原可改善高血栓负荷STEMI病人急诊PCI术后心肌灌注,降低心源性死亡发生风险,且不增加出血风险。

Objective To investigate the effect of thrombus aspiration combined with prourokinase on safety and effectiveness in the treatment of ST-segment elevation myocardial infraction(STEMI)patients with high thrombus burden during primary percutaneous coronary intervention(PPCI).Methods A total of 175 STEMI patients who underwent PPCI in Hebei General Hospital from February 2017 to February 2019 were selected,and divided into thrombus aspiration group(111 cases)and thrombus aspiration combined with prourokinase group(64 cases).Baseline clinical data and PPCI data were collected.The incidence of main adverse cardiovascular and cerebrovascular events(MACCE)and hemorrhagic events were recorded and compared between two groups in hospital and at 12 months follow-up.Results The patients in thrombus aspiration combined with prourokinase group were younger than those in thrombus aspiration group(P<0.05).The incidence of slow flow/no-reflow in thrombus aspiration combined with prourokinase group was lower than that in thrombus aspiration group(12.5%and 25.2%,P<0.05).The incidence of cardiac death in thrombus aspiration combined with prourokinase group was lower than that in thrombus aspiration group during hospital and at 12 months follow-up(P<0.05).There were no significant difference in the incidence of heart failure,target vessal revascularization,re-myocardial infarction,stroke,and hemorrhagic events between two groups(P>0.05).Kaplan-Meier analysis showed that there was no significant difference in the survival rate of non-MACCE between two groups at 12 months after surgery(P=0.206).Conclusion Thrombus aspiration combined with prourokinase could improve myocardial perfusion during PPCI in STEMI patients with high thrombus burden,ruduce cardiac death,without increasing the risk of bleeding.