延迟支架植入对高血栓负荷ST段抬高型心肌梗死患者的影响

Effect of Delayed Stent Implantation on Patients with Thrombotic High Load ST-elevation Myocardial Infarction

目的:探讨延迟支架植入对高血栓负荷ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者的影响。方法:回顾性分析2016年1月-2020年6月潮州市中心医院收治的515例高血栓负荷STEMI患者,最终入选427例患者。依据支架植入时间,将其分为延迟支架植入策略(delayed stenting strategy,DS)组(n=101)和即刻支架植入策略(immediate stenting strategy,IS)组(n=326)。收集两组基本资料及病变情况、实验室指标,IS组于首次造影时植入支架。DS组在5~7 d内冠心病二级预防后进行了第二次介入手术干预。比较两组基本资料及病变情况、实验室指标,主要终点事件及次要终点事件。结果:两组年龄、性别、BMI、心率、糖尿病、高血压、高脂血症、吸烟、既往心肌梗死、既往PCI占比、LVEF、有无使用阿司匹林、氯吡格雷/替格瑞洛、他汀、ACEI/ARB占比比较差异均无统计学意义(P>0.05)。两组靶血管(前降支、回旋支、右冠状动脉)、多支血管病变占比、造影剂剂量、门-球时间、肌酐、尿酸、低密度脂蛋白、高密度脂蛋白、甘油三酯、胆固醇水平比较差异均无统计学意义(P>0.05)。DS组没有发生无复流事件,其中12例(11.9%)复查造影残余狭窄小于30.0%,未行支架植入术。最终,DS组无复流/慢血流事件的发生率显著低于IS组(7.9%vs 16.0%)(P<0.05)。住院期间,两组心力衰竭、心律失常、再梗死发生率、住院总费用比较差异均无统计学意义(P>0.05)。1年的随访中,DS组的主要不良心血管事件(MACEs)发生率显著低于IS组(P<0.05)。结论:在高血栓负荷STEMI患者中,延迟支架植入有可能降低无复流现象的风险。这种方法相对安全,与更好的临床结果相关。

Objective:To investigate the effect of delayed stent implantation on patients with thrombotic high load ST-elevation myocardial infarction(STEMI).Method:A total of 515 patients with thrombotic high load STEMI treated in Chaozhou Central Hospital from January 2016 to June 2020 were retrospectively analyzed,and 427 patients were finally selected.According to the time of stent implantation,they were divided into delayed stenting strategy(DS)group(n=101)and immediate stenting strategy(IS)group(n=326).The basic data,pathological condition and laboratory indexes of the two groups were collected.The stent was implanted in the IS group at the first angiography.A second interventional surgical intervention was performed in the DS group after 5-7 days of secondary prevention of coronary heart disease.The basic data,pathological condition,laboratory indexes,primary endpoint events and secondary endpoint events were compared between the two groups.Result:There were no significant differences in age,sex,BMI,heart rate,diabetes,hypertension,hyperlipidemia,smoking,previous myocardial infarction,previous PCI proportions,LVEF,Aspirin,Clopidogrel/Ticagrelor,Statin,ACEI/ARB use proportions between the two groups(P>0.05).There were no significant differences between the two groups in target vessels(anterior descending branch,circumflex branch,right coronary artery),multiple vessels lesions proportion,contrast medium dose,door to balloon time,creatinine,uric acid,low-density lipoprotein,high-density lipoprotein,triglyceride and cholesterol levels(P>0.05).In DS group,no non reflow event occurred,of which 12 cases(11.9%)had residual stenosis less than 30.0%in recheck angiography and no stent implantation.Finally,the incidence of no reflow/slow flow events in DS group was significantly lower than that in IS group(7.9%vs 16.0%)(P<0.05).During hospitalization,there were no significant differences in the incidences of heart failure,arrhythmia and reinfarction and the total cost of hospitalization between the two groups(P>0.05).During one-year follow-up,the incidence of major adverse cardiovascular events(MACEs)in DS group was significantly lower than that in IS group(P<0.05).Conclusion:In patients with thrombotic high load STEMI,delayed stent implantation may reduce the risk of no reflow.This method is relatively safe and is associated with better clinical outcomes.