血栓抽吸在急性心肌梗死患者急诊经皮冠状动脉介入治疗中应用价值

Application of thrombus aspiration in primary percutaneous coronary intervention for acute myocardial infarction

目的评价血栓抽吸在急性心肌梗死急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的疗效。方法急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)接受急诊PCI患者85例,其中血栓抽吸+PCI治疗者40例为联合组,单纯行PCI治疗者45例为单纯组。比较2组基础临床资料、手术时间、罪犯血管分布、术前罪犯TIMI血流分级情况、术后即刻TIMI血流Ⅲ级、术后2hST段回落≥50%、术后7d左室射血分数≥50%、术后即刻无复流、住院期间再发心肌梗死发生率和住院期间病死率。结果 2组性别比例、年龄、吸烟史、合并高血压、糖尿病比例、发病时间等比较差异无统计学意义(P>0.05);联合组手术时间[(55.0±31.0)min]、罪犯血管分布、术前罪犯血管TIMI血流分级情况与单纯组[(54.0±32.0)min]比较差异均无统计学意义(P>0.05);联合组术后即刻无复流、住院期间再发心肌梗死发生率(5.0%、2.5%)明显低于单纯组(15.6%、6.7%)(P<0.05),术后即刻冠状动脉TIMI血流Ⅲ级、术后2hST段回落≥50%、术后7d左室射血分数≥50%发生率(92.5%、90.0%、60.0%)明显高于单纯组(84.4%、77.8%、40.0%)(P<0.05),住院期间病死率(2.5%)与单纯组(2.2%)比较差异无统计学意义(P>0.05)。结论血栓抽吸可提高急诊PCI成功率,有较好的安全性、可行性。

Objective To evaluate the effect of thrombus aspiration on primary percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction(STEMI).Methods Eighty-five patients with STEMI undergoing primary PCI were divided into combined group receiving PCI plus thrombus aspiration(n=40)and PCI group receiving only PCI(n=45).These two groups were compared the basic clinic data,operation lasting time,culprit vessel distribution,TIMI grading of culprit vessels,immediate postoperative TIMI grade Ⅲ flow,ST-segment resolution ≥50%in 2hafter PCI,LVEF ≥50%in 7d,the incidence of immediate postoperative no-flow,the incidence of recurrent myocardial infarction,and hospitalization fatality.Results There were no significant differences in the gender,age,smoking history,proportion of complications of hypertension and diabetes mellitus and onset time of STEMI between two groups(P>0.05).There were no significant differences in the operation lasting time((55.0±31.0)min vs(54.0±32.0)min),culprit vessel distribution and TIMI grading of culprit vessels between combined group and PCI group(P>0.05).The incidences of immediate postoperative no-reflow(5.0%)and recurrent myocardial infarction(2.5%)were significantly lower in combined group than those in PCI group(15.6%,6.7%)(P<0.05).Combined group had significantly higher incidences of immediate postoperative TIMI gradeⅢflow(92.5%),ST-segment resolution≥50%in2hafter PCI(90.0%)and LVEF≥50%in 7d(60.0%)than PCI group(84.4%,77.8%,40.0%)(P<0.05).There was no significant differences in the hospitalization fatality between combined group(2.5%)and PCI group(2.2%)(P>0.05).Conclusion Thrombus aspiration can improve the success rate of primary PCI,with high safety and feasibility.