准分子激光冠状动脉成形术治疗急性ST段抬高型心肌梗死高血栓负荷病变中应用的安全性和有效性

Analysis of excimer laser coronary angioplasty for treatment of STelevation myocardial infarction with thrombus-rich lesions

目的观察准分子激光冠状动脉成形术(excimer laser coronary angioplasty,ELCA)在急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)高血栓负荷病变中应用的安全性和有效性。方法纳入2019年3月~2022年8月在云南省阜外心血管病医院冠心病中心治疗的35例STEMI高血栓负荷病变患者,其中10例使用ELCA,25例应用血栓抽吸预处理血栓病变,后根据预处理结果决定行支架植入、球囊扩张或择期手术。观察术后TIMI血流分级、校正TIMI血流帧数(correct TIMI frame count,cTFC)、术后90 min ST段回落率(STsegment revolution,STR),观察两组住院期间心源性死亡、再发心梗与脑梗等主要心脑事件。结果与血栓抽吸组比较,STEMI高血栓负荷病变ELCA治疗可改善术后cTFC(P<0.05),减少替罗非班使用比例(P<0.05),即刻植入支架比例高于血栓抽吸组(P<0.05)。ELCA组无冠脉夹层、穿孔、慢血流、无复流等并发症发生,血栓抽吸组2例术中出现分支栓塞,ELCA组住院期间未发生主要心脑血管事件。结论应用ELCA辅助STEMI高血栓负荷病变PCI治疗安全有效,可显著减少相关并发症。

AIM To evaluate the effect and safety of excimer laser coronary angioplasty(ELCA)used in patients of STEMI with thrombus-rich lesions.METHODS Thirty-five patients with severe thrombosis lesions were pretreated with ELCA(n=10)or manual thrombectomy(n=25)and then they were treated with routine PCI in Fuwai Yunnan Hospital.The operative success rate was observed by TIMI flow rate,corrected TIMI frame count(cTFC),ST-segment revolution(STR)and in-hospital major adverse cardiocerebral events(MACCEs),including cardiovascular death and MI(stent thrombosis included).Stroke was also investigated.RESULTS Compared with the thrombus aspiration group,ELCA treatment for STEMI with high thrombus burden lesions can improve postoperative cTFC(P<0.05),reduce the proportion of tirofiban use(P<0.05),and immediately implant stents more frequently than the thrombus aspiration group(P<0.05).There were no complications such as coronary dissection,perforation,slow blood flow,or reflow in the ELCA group.Two cases in the thrombus aspiration group experienced branch embolism during surgery,and there were no major cardiovascular or cerebrovascular events during hospitalization in the ELCA group.CONCLUSION The application of ELCA assisted PCI for STEMI high thrombotic burden lesions is safe and effective,and can significantly reduce related complications.