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急性ST段抬高心肌梗死患者经皮冠状动脉介入治疗时远端微循环保护的随机对照试验 被引量:3
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作者 Stone G.W. webb j. +1 位作者 Cox D.A. 黄卫东 《世界核心医学期刊文摘(神经病学分册)》 2005年第7期5-6,共2页
Context: Atheromatous and thrombotic embolization during percutaneous coronary intervention (PCI) in acute myocardial infarction is common and may result in m icrocirculatory dysfunction, the prevention of which may i... Context: Atheromatous and thrombotic embolization during percutaneous coronary intervention (PCI) in acute myocardial infarction is common and may result in m icrocirculatory dysfunction, the prevention of which may improve reperfusion suc cess, reduce infarct size, and enhance event-free survival. Objective: To deter mine whether protection of the distal microcirculation from thromboembolic debri s liberated during primary PCI results in improved reperfusion and decreased inf arct size.Design, Setting, and Patients: Prospective randomized controlled trial at 38 academic and community-based institutionsin 7 countries enrolling 501 pa tients aged 18 years or older with ST-segment elevation myocardial infarction(S TEMI) presenting within 6 hours of symptom onset and undergoing primary PCI or r escue intervention after failed thrombolysis. Interventions: Patients were rando mized between May 20, 2002, and November 21, 2003, to receive PCI with a balloon occlusion and aspiration distal microcirculatory protection system vs angioplas ty without distal protection. Main Outcome Measures:Coprimary end points were ST -segment resolution(STR) measured 30 minutes after PCI by continuous Holter mon itoring and infarct size measured by technetium Tc 99m sestamibi imaging between days 5 and 14. Secondary end points included major adverse cardiac events. Resu lts: Among 252 patients assigned to distal protection, aspiration was performed in 97%(242/251), all angioplasty balloon inflations were fully protected in 79 %(193/245), and visible debris was retrieved from 73%(182/250). Complete STR w as achieved in a similar proportion reperfused with vs without distal protection (63.3%[152/240] vs 61.9%[148/239], respectively; absolute difference,1.4%[95 %confidence interval, -7.7%to 10.5%;P = .78]), and left ventricular infarct size was similar in both groups (median, 12.0%[n = 229] vs 9.5%[n = 208],respe ctively; P = .15). Major adverse cardiac events at 6 months occurred with simila r frequency in the distal protection and control groups (10.0%vs 11.0%, respec tively;P = .66). Conclusions: A distal balloon occlusion and aspiration system e ffectively retrieves embolic debris in most patients with acute STEMI undergoing emergent PCI.Nonetheless, distal embolic protection did not result in improved microvascularflow, greater reperfusion suc cess,reduced infarct size, or enhanced event-free survival. 展开更多
关键词 随机对照试验 介入治疗 微循环障碍 INFARCT 再灌注 血栓形成性 血管成形术 THROMBOLYSIS HOLTER elevation
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急性ST段抬高的心肌梗死患者行经皮冠状动脉介入时对远端微循环的保护:一项随机对照试验 被引量:3
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作者 Stone G.W. webb j. +1 位作者 Cox D.A. 赵和平 《世界核心医学期刊文摘(心脏病学分册)》 2005年第7期21-22,共2页
Context: Atheromatous and thrombotic embolization during percutaneous coronary intervention(PCI) in acute myocardial infarction is common and may result in microcirculatory dysfunction, the prevention of which may imp... Context: Atheromatous and thrombotic embolization during percutaneous coronary intervention(PCI) in acute myocardial infarction is common and may result in microcirculatory dysfunction, the prevention of which may improve reperfusion success, reduce infarct size, and enhance event-free survival. Objective: To determine whether protection of the distal microcirculation from thromboembolic debris liberated during primary PCI results in improved reperfusion and decreased infarct size. Design, Setting, and Patients: Prospective randomized controlled trial at 38 academic and community-based institutions in 7 countries enrolling 501 patients aged 18 years or older with ST-segment elevation myocardial infarction(STEMI) presenting within 6 hours of symptom onset and undergoing primary PCI or rescue intervention after failed thrombolysis. Interventions: Patients were randomized between May 20, 2002, and November 21, 2003, to receive PCI with a balloon occlusion and aspiration distal microcirculatory protection systemvs angioplasty without distal protection. Main Outcome Measures: Coprimary end points were ST-segment resolution(STR) measured 30 minutes after PCI by continuous Holter monitoring and infarct size measured by technetium Tc 99m sestamibi imaging between days 5 and 14. Secondary end points included major adverse cardiac events. Results: Among 252 patients assigned to distal protection, aspiration was performed in 97%(242/251), all angioplasty balloon inflations were fully protected in 79%(193/245), and visible debris was retrieved from 73%(182/250). Complete STR was achieved in a similar proportion reperfused with vs without distal protection(63.3%[152/240] vs 61.9%[148/239], respectively; absolute difference, 1.4%[95%confidence interval,-7.7%to 10.5%; P=.78]), and left ventricular infarct size was similar in both groups(median, 12.0%[n=229] vs 9.5%[n=208], respectively; P=.15). Major adverse cardiac events at 6 months occurred with similar frequency in the distal protection and control groups(10.0%vs 11.0%, respectively; P=.66). Conclusions: A distal balloon occlusion and aspiration system effectively retrieves embolic debris in most patients with acute STEMI undergoing emergent PCI. Nonetheless, distal embolic protection did not resultin improved microvascularflow, greater reperfusion success, reduced infarct size, or enhanced event-free survival. 展开更多
关键词 ST段抬高 随机对照试验 补救性介入 再灌注 血管成形术 介入治疗 梗死范围 心脏不良事件 栓塞性 不良心脏事件
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