直接支架置入与预扩张后支架置入处理急性心肌梗死相关病变的对比研究

Comparison of coronary stenting with or without predilation for infarct related lesions in patients with acute myocardial infarction

目的 探讨直接支架置入术处理急性心肌梗死相关病变 (IRL)的安全性、可行性 ,以及扩张压对无复流 慢血流发生率的影响。方法 发病 4 8h内行介入治疗的首次急性心肌梗死患者 ,在导丝通过后IRL开通 ,弥漫性或巨大血栓形成、明显钙化、长度≥ 2 0mm的病变除外。比较球囊预扩张组 (A组 )、直接支架组 (B组 )的成功率和严重并发症发生率。比较最大扩张压≤ 12 16kPa(12atm ,1atm =10 1 32 5kPa) ,与 >12 16kPa患者支架置入后即刻无复流 慢血流的发生率。结果 A组 35例 ,B组 4 2例 ,A、B组的成功率分别为 10 0 %和 95 % ,B组 2例 (5 % )因IRL成角 ,支架无法直接通过 ,球囊预扩张后均成功置入原支架。两组无 1例发生介入治疗相关的严重心脏事件 (死亡、再梗死、急诊冠状动脉旁路移植术 )。最大扩张压≤ 12 16kPa和 >12 16kPa患者支架置入后即刻无复流 慢血流的发生率分别为 7%和 32 % (P <0 0 5 )。结论 直接置入支架术处理IRL ,安全可行 ,成功率高 ;高压扩张置入支架后即刻无复流 慢血流发生率高。

Objective To assess the clinical efficacy of direct stenting (DS) for infarct related lesions (IRL) in patients with acute myocardial infarction (AMI) and the effect of inflation pressure on the incidence of no-reflow. Methods Patients with first AMI undergoing percutaneous coronary interventions (PCI) within 48 hours of onset were divided into two groups: pre-dilation group (group A, n=35); DS group (group B, n=42). The procedural success and the incidence of major cardiac events were compared between two groups. The incidences of no-reflow immediately after stenting were also compared between patients undergoing high-[>1?216 kPa(12 atm, 1 atm=101.325 kPa)] or low- (≤1?216 kPa) pressure inflation. Results In group A, all patients were successfully treated with PCI. In group B, 40 cases (95%) were successfully treated with DS, and DS in the remaining 2 patients failed due to an angle in IRL, which were successfully managed with pre-dilation. There were no procedure-related death, re-infarction, or emergency bypass surgery in both groups. The incidence of no-reflow after stenting was significantly higher in patients with high-pressure inflation than in those with low-pressure inflation (32% vs 7%, P<0.05). Conclusion It is safe and feasible to treat IRL with DS, and high-pressure inflation is associated with high incidence of no-reflow after stenting.