Additional manual thrombus aspiration for ST-segment elevation myocardial infarction during percutaneous coronary intervention： an updated meta- analysis

Background The clinical efficacy and safety of adjunctive thrombus aspiration （TA） in patients with ST-segment elevation myocardial infarction （STEMI） during percutaneous coronary intervention （PCI） remain controversial. Methods Twenty five eligible randomized controlled trials were included to compare the use of thrombus aspiration （TA） with PCI and PCI-only for STEMI. The primary endpoint was all-cause mortality and death. The secondary endpoints were major adverse cardiac events （MACE）, recurrent infarction （RI）, target vessel revascularization （TVR）, stent thrombosis （ST）, perfusion surrogate markers and stroke. Results TIMI flow grade 3 and MBG 2-3 were significantly increased in the TA plus PCI arm compared with the PCI-only arm [relative risk （RR）： 1.05, 95% confidence intervals （CI）： 1.02-1.09, P = 0.004] and （RR： 1.68, 95% CI： 1.40-2.00, P 〈 0.001）, respectively. There were no significant differences in all-cause mortal- ity, MACEs, TVR and ST rates between the two groups. The RI rate was lower in the TA plus PCI arm than that in the PCI-only arm with short-term follow-up duration （RR： 0.60, 95% CI： 0.38-0.96, P = 0.03）, but there was no significant difference in RI incidence over the me- diumor long-term follow-up periods （RR： 1.00, 95% CI： 0.77-1.29, P = 0.98）, and （RR： 0.96, 95% CI： 0.81-1.15, P = 0.69）, respectively. There were statistically significant differences in the rates of crude stroke and stroke over the medium- or long-term follow-up periods and the crude stroke rate in the TA plus PCI （RR： 1.60, 95% CI： 1.08-2.38, P = 0.02） and （RR： 1.43, 95% CI： 1.03-1.98, P = 0.03）, respectively; this was not observed between the two arms during the short-term follow-up period （RR： 1.47, 95% CI： 0.97-2.21, P = 0.07）. Conclusions Routine TA-assisted PCI in STEMI patients can improve myocardial reperfusion and get limited benefits related to the clinical endpoints, which may be associated with stroke risk.

Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

AIM: To evaluate the impact of thrombus aspiration(TA) on procedural outcomes in a real-world ST-segment elevation myocardial infarction(STEMI) registry.METHODS: From May 2006 to August 2008, 542 consecutive STEMI patients referred for primary or rescue percutaneous coronary intervention were enrolled and the angiographic results and stent implantation characteristics were compared according to the performance of manual TA.RESULTS: A total of 456 patients were analyzable and categorized in TA group(156 patients; 34.2%) and non-TA(NTA) group(300 patients; 65.8%). Patientstreated with TA had less prevalence of multivessel disease(39.7% vs 54.7%, P = 0.003) and higher prevalence of initial thrombolysis in myocardial infarction flow 【 3(P 【 0.001) than NTA group. There was a higher rate of direct stenting(58.7% vs 45.5%, P = 0.009), with shorter(24.1 ± 11.8 mm vs 26.9 ± 15.7 mm, P = 0.038) and larger stents(3.17 ± 0.43 mm vs 2.93 ± 0.44 mm, P 【 0.001) in the TA group as compared to NTA group. The number of implanted stents(1.3 ± 0.67 vs 1.5 ± 0.84, P = 0.009) was also lower in TA group. CONCLUSION: In an “all-comers” STEMI population, the use of TA resulted in more efficient procedure leading to the implantation of less number of stents per lesion of shorter lengths and larger sizes.

Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration

Aim of the work: To evaluate the efficacy and safety of bolus only intra coronary platelet glyco-protein GP IIb/IIIa receptor antagonists combined with thrombus-aspiration during percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Patient and Methods: 25 consecutive STEMI patients treated by primary PCI including thrombus aspiration were prospectively enrolled, from a total of 180 PCIs performed at our institution between January 2013 and January 2014. All patients received aspirin (250 mg i.v.) and clopidogrel (600 or 300 mg if already on clopidogrel) plus standard heparin. Glycoprotein IIb/IIIa antagonists were administered at physicians’ discretion before thrombus aspiration. Eptifibatide was used as a slandered Glycoprotein IIb/IIIa antagonists as a dose of the 180-μg/kg eptifibatide bolus only. The bolus was administered for 2 minutes via the thrombus aspiration catheter (STEMI cath of min-vasys) just before thrombus aspiration. Twelve-lead ECGs were recorded at baseline and 60 min (45 - 75 min) after completion of PCI. The primary endpoint was the TIMI 3 patency of the infarct-related coronary artery before PCI. Secondary endpoints were TIMI patency following PCI, ST resolution 60 min after PCI, all-cause death, reinfarction, urgent revascularization, stroke (haemorrhagic, non-haemorrhagic), and severe bleeding complications. Results: The angiography was performed in all 25 patients. The incidence of a TIMI flow grade 3 of the infarct-related coronary artery before PCI was 16% while TIMI grade 2 and I was 24% and 36% respectively. The incidence of a TIMI flow grade 0 (no reflow) of the infarct-related coronary artery before PCI was 24%. Visible thrombus in 52% of patients and 40% of patients have more than one critically disease vessel. Primary PCI was performed in 25 patients. Eptifibatide intracoronary was given through thrombus aspiration catheter before thrombus aspiration. Drug eluting stents were implanted in 60% of patients. Only two patients with acute stent thrombosis did not receive any stents at PCI. One patient died 24 h after the procedure due to severe heart failure and cardiogenic shock. No reinfarction was noted within 30 days after the procedure. Generally heart failure improved significantly after the procedure and at the end of 30 day post operative. Only 3 patients had persistent heart failure class III (12%). 84% of patients had TIMI flow III at the end of procedure with over all significant improvement. Significant TIMI flow improvement after procedure was noticed with P value, 001. Also the results showed significant shows of ST segment resolution after procedure. Conclusions: for patients with STEMI undergoing primary PCI, a routine combination of intracoronary administration of Eptifibatide before transcatheter thrombus aspiration is a safe procedure with low risk of hemorrhage and increases myocardial reperfusion, which ultimately improves outcomes. This therapeutic modality may be recommended for further improving myocardial reperfusion in patients with STEMI.

Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction:A review of clinical evidence and guidelines

Acute ST segment elevation myocardial infarction(STEMI) is characterized by complete thrombotic occlusion of a major coronary artery. Early recanalization of the infarct-related artery is most efficiently delivered by primary percutaneous coronary intervention(PPCI),however this does not always restore normal myocardial perfusion,mainly due to distal embolization of the thrombus and microvascular obstruction. Early evidence for manual thrombus aspiration during PPCI was promising and this was once considered an important aspect of the procedure,especially in patients with a high thrombus burden. However,a large body of evidence from recent major randomized controlled trials(notably TASTE and TOTAL) does not support the routine use of manual thrombus aspiration in patients with STEMI undergoing PPCI.

Thrombus aspiration in acute myocardial infarction:Rationale and indication

Reperfusion of myocardial tissue is the main goal of primary percutaneous coronary intervention(PPCI) with stent implantation in the treatment of acute ST-segment elevation myocardial infarction(STEMI). Although PPCI has contributed to a dramatic reduction in cardiovascular mortality over three decades, normal myocardial perfusion is not restored in approximately one-third of these patients. Several mechanisms may contribute to myocardial reperfusion failure, in particular distal embolization of the thrombus and plaque fragments. In fact, this is a possible complication during PPCI, resulting in microvascular obstruction and no-reflow phenomenon. The presence of a visible thrombus at the time of PPCI in patients with STEMI is associated with poor procedural and clinical outcomes. Aspiration thrombectomy during PPCI has been proposed to prevent embolization in order to improve these outcomes. In fact, the most recent guidelines suggest the routine use of manual aspiration thrombectomy during PPCI(class Ⅱa) to reduce the risk of distal embolization. Even though numerous international studies have been reported, there are conflicting results on the clinical impact of aspiration thrombectomy during PPCI. In particular, data on long-term clinical outcomes are still inconsistent. In this review, we have carefully analyzed literature data on thrombectomy during PPCI, taking into account the most recent studies and meta-analyses.

Transcatheter Aspiration of Coronary Thrombus in Patients with Acute Myocardial Infarction

Objectives We introduced a simple method of transcatheter aspiration of coronary thrombus during emergency PCI in acute myocardial infarction (AMI) patients. Methods AMI patients presenting proximal coronary lesions with intracoronary thrombus were selected. We used the common coronary wire (0. 014') across the lesion after 7F guiding catheter to the ostium of coronary arteries. Aspiration catheter (Export, PercuSurge) was directly advanced over the wire to the lesion and manually aspirated the thrombus with a 20 - ml syringe at the same time. After thrombus disappeared and occluded arteries reopened, stents were directly implanted. Results 12 cases of AMI received the treatment. After aspiration, the thrombus disappeared in 8 cases, and decreased in another 4 cases. The total occluded artery was directly re- opened and the antegrade flow improved markedly after aspiration in 7 out of 8 cases. 9 patients achieved TIMI 3 flow and TMP 3 grade perfusion flow after stenting, and the other 3 cases were TMP 2. No major cardiac events took place during hospitalization. The LVEF was 64.1 ± 9. 3% before discharge. Conclusions Transcatheter aspiration of thrombus is a simple and effective method to manage the intracoronary thrombus in AMI patients.

Thrombosis in ST-elevation myocardial infarction:Insights from thrombi retrieved by aspiration thrombectomy

In patients with ST-elevation myocardial infarction, recurrent cardiovascular events still remain the main cause of morbidity and mortality, despite significant improvements in antithrombotic therapy. We sought to review data regarding coronary thrombus analysis provided by studies using manual aspiration thrombectomy(AT), andto discuss how insights from this line of investigation could further improve management of acute coronary disease. Several studies investigated the fresh specimens retrieved by AT using techniques such as traditional morphological evaluation, optical microscopy, scanning electron microscopy, magnetic resonance imaging, and immunohistochemistry. These approaches have provided a better understanding of the composition and dynamics of the human coronary thrombosis process, as well as its relationship with some clinical outcomes. Recent data signaling to new antithrombotic therapeutic targets are still emerging.

急性心肌梗死高血栓负荷影响因素分析及应用ThrombusterⅡ血栓抽吸导管改善心肌灌注观察

目的 分析急性ST段抬高型心肌梗死（STEMI）高血栓负荷的影响因素及应用ThrombusterⅡ血栓抽吸导管对心肌灌注的影响.方法 选择首次因STEMI行急诊PCI患者110例,据血栓积分分为高血栓负荷组和低血栓负荷组,再依据术中选择分为血栓抽吸组及标准PCI组,分别比较两组患者临床基线情况、冠状动脉造影、心肌灌注及心电图ST段回落情况.以血栓积分≥2分为因变量采用Logistic回归模型分析高血栓负荷的独立危险因素.结果 同低血栓负荷组相比,高血栓负荷组吸烟者比例较高（59.4％比44.9％,P＜0.05）,症状开始至再灌注时间较长[（7.9±4.7）h比（5.4±3.5）h,P＜0.05],术中应用GPⅡb/Ⅲa比例高（93.8％比80.1％,P＜0.05）.与标准PCI组相比较,血栓抽吸组TMPG达3级者较多（P＜0.05）,TMPG≤2级者比例更低,CTFC帧数较少（P＞0.05）.多因素分析示,年龄＞75岁、吸烟、症状开始至再灌注时间＞6 h是STEMI患者高血栓负荷的独立危险因素.结论年龄＞75岁、吸烟、症状开始至再灌注时间＞6 h是STEMI患者高血栓负荷的独立危险因素.应用ThrombusterⅡ血栓抽吸导管可减少STEMI患者PCI后无复流及慢血流的发生,改善心肌组织灌注.

急性STEMI应用ThrombusterⅡ抽吸导管联合冠状动脉内注射替罗非班的疗效观察

目的 观察对急性ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入（PCI）手术中应用血栓抽吸导管联合冠状动脉内注射替罗非班的疗效.方法 选择因STEMI行直接PCI并于术中应用Thrombuster Ⅱ血栓抽吸导管联合冠状动脉内推注替罗非班的患者65例作为治疗组,以基础临床资料和冠状动脉影像特征相似并单纯行直接PCI的60例患者作为对照组,观察临床疗效.结果 治疗组在TIMI 3级血流、校正TIMI帧数、术后2 h ST段回落程度、酶峰值和峰值时间以及梗死相关血管（IRA）无复流发生率均优于对照组（P＜0.05或 0.01）.治疗组术后3个月左心室射血分数（LVEF）、左心室舒张末径（LVEDd）、左心室收缩末径（LVESd）及主要不良心血管事件（MACE,包括死亡、再梗死、再次靶血管重建）的发生率少于对照组（P＜0.05）,而术后1周时两组差异无统计学意义（P ＞0.05）.结论 STEMI患者行直接PCI过程中应用血栓抽吸导管联合冠状动脉内推注替罗非班可减少无复流的发生,改善心肌再灌注水平及左心室功能.

Manual aspiration thrombectomy in acute ST elevation myocardial infarction:New gold standard?

Percutaneous coronary intervention(PCI) is the preferred method to treat ST segment myocardial infarction(STEMI).The use of thrombus aspiration(TA) may be particularly helpful as part of the PCI process,insofar as the presence of thrombus is essentially a universal component of the STEMI process.This article reviews evidence favoring the routine use of TA,and the limitations of these data.Based on current evidence,we consider TA to be an important maneuver during STEMI PCI,even in the absence of visible angiographic thrombus,and recommend it whenever the presence of thrombus is likely.

Removal of refractory thrombus by 5F child catheter in patients with subacute myocardial infarction

No-reflow phenomenon is common in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI),and it is strongly associated with adverse clinical prognosis.Previous studies have shown that heavy thrombus burden could predict the development of no-reflow in PCI.Manual and mechanical thrombus aspiration catheters are widely used;however,there is still residual refractory thrombus left after the routine use of thrombectomy,especially in patients with subacute myocardial infarction(SMI).In our practice,child catheter aspiration has been used as a safe and effective approach to solve the residual thrombus in SMI patients.We described this technique in detail by a series of cases.

Thrombus aspiration plus intra-infarct-related artery administration of tirofiban improves myocardial perfusion during primary angioplasty for acute myocardial infarction

Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction （STEMI）. This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group （97.22% vs. 87.04%, X2=7.863, P=0.049）. The peak of CK-MB （83.9 （68.9-310.5） U/L vs. 126.1 （74.7-356.7） U/L, P=0.034） and Tnl （42.7 （14.7-113.9） ng/ml vs. 72.5 （59.8-135.3） ng/ml, FMD.029） were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, （45.7±8.3）% to （42.9±12.1）%, t=1.98, P=0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference （Log-rank X2=2.865, P=0.09）. There was no statistical difference in any bleeding events between the two groups.Conclusions Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.

吸、溶栓术联合血管腔内成形术在布-加综合征合并下腔静脉血栓形成治疗中的应用

目的:探讨吸、溶栓术联合血管腔内成形术治疗布-加综合征(Budd-Chiari syndrome,BCS)合并下腔静脉(IVC)血栓形成中的效果。方法:对11例BCS合并IVC血栓形成患者经股静脉穿刺行IVC造影,采用吸栓加溶栓技术消除血栓,后行腔内球囊扩张血管成形术。出院后采用彩色多普勒随访IVC有无再狭窄或闭塞。结果:11例均为IVC膜性阻塞,采用吸栓加溶栓后血栓完全消失7例;保留IVC导管溶栓4 d后血栓消失2例;7 d后消失2例;腔内球囊扩张血管成形术后均未出现肺栓塞症状。术后随访IVC通畅良好,无IVC再阻塞及血栓形成发生。结论:吸栓加溶栓术联合血管腔内成形术治疗BCS合并IVC血栓形成的效果良好。

应用血栓抽吸术对急性心肌梗死患者Tp-e、 Tp-e/QT的影响

目的 探讨应用血栓抽吸对行直接经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者Tp-e及Tp-e/QT的影响.方法 选取同期发病12h内行直接PCI罪犯血管（IRA）内存在血栓负荷重的STMEI患者110例,随机分成血栓抽吸组（血栓抽吸＋PCI）及对照组（单纯PCI）.测量两组PCI术前及术后2h心电图中Tp-e及Tp-e/QT,并观察两组在住院期间发生恶性心律失常的情况.结果 两组在性别、年龄、心血管风险因子、症状发作至球囊扩张时间、PCI术前Tp-e及Tp-e/QT等方面比较未见统计学差异（P＞0.05）.血栓抽吸组PCI术后ST段回落＞70％的比率、Tp-e及Tp-e/QT减少的幅度均高于对照组[60.00％比40.00％,（22.66±9.91）ms比（15.89±8.24）ms,0.04±0.03比0.03±0.02,P均＜0.05];血栓抽吸组PCI术后Tp-e、Tp-e/QT及术后至出院前发生恶性心律失常的比率均低于对照组[（88.54±13.13）ms比（93.7l±11.00）ms,0.25±0.03比0.26±0.03,16.00％比33.33％,P均＜0.05].结论 对于冠状动脉内血栓负荷重的急性STEMI患者,直接PCI术时应用血栓抽吸可以更多地减少心室复极离散度指标Tp-e及Tp-e/QT,降低心肌梗死后恶性室性心律失常发生的风险.其原因可能与血栓抽吸有助于更好地恢复微循环再灌注水平有关.

Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

AIM: To assess the diagnostic accuracy of endoscopic ultrasound (EUS), fluid tumor markers and cytology in distinguishing benign from (pre)malignant pancreatic cystic lesions. METHODS: 46 consecutive patients, referred to a gastroenterologist and surgeon for a symptomatic or incidental pancreatic cyst, were reviewed. EUS, cytology, and carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) levels were compared with the final diagnosis, based on surgical pathology and/or imaging follow-up of at least 12 mo. Cysts were classified as benign (pseudocyst, serous cystadenoma) or malignant/ pre-malignant (mucinous cystic neoplasm). Receiver- operator characteristics (ROC) curve analysis was performed. RESULTS: The mean age was 56 years; 29% were male and median cyst diameter was 3 cm. Final outcome was obtained in 41 (89%) patients. Twenty-three (56%) of these 41 had surgical pathology. Twenty-three (56%) had benign lesions and 18 (44%) had malignant/pre- malignant lesions. Sensitivity, specificity and positive and negative predictive value of EUS alone to distinguish benign from malignant/premalignant pancreatic cystic lesions were 50%, 56%, 36% and 54% and for cytology were 71%, 96%, 92% and 85%, respectively. The corresponding values for the ROC-derived ideal cutoffswere 75%, 90%, 75%, 90% for CA 19-9 (> 37 U/mL) and 70%, 85%, 79% and 78% for CEA (> 3.1 ng/mL). Subgroup analysis of those with surgical pathology yielded almost identical performance and cutoffs. CONCLUSION: Cytology and cyst fluid tumor marker analysis is a very useful tool in distinguishing benign from (pre)malignant pancreatic cystic lesions.

血栓抽吸术联合PCI对急性ST段抬高型心肌梗死患者血清ITLN-1水平的影响

目的探讨经皮冠状动脉介入术(PCI)联合抽吸血栓与单纯常规PCI术对急性ST段抬高心肌梗死(STEMI)患者血清凝集蛋白-1 (ITLN-1)、血流灌注水平、心功能和预后的影响。方法选取2010年1月至2014年6月就诊于桂林市人民医院心内科行PCI术的STEMI患者549例,根据是否行血栓抽吸将其分为血栓抽吸联合PCI组(联合组) 381例和单纯PCI组168例。比较两组患者的术后血流TIMI分级、术后1周心功能情况[左室射血分数(LVEF)和左室舒张末期内径(LVDD)]、术后血清肌酸激酶(CK)和其同工酶(CK-MB)的峰值及ST段回落情况;酶联免疫法检测入院时、术后24 h、1周和6个月两组患者的血清ITLN-1水平,随访术后6个月发生的主要心血管不良事件。结果联合组与单纯PCI组患者入院时的血清ITLN-1水平分别为(141.5±87.2) ng/mL和(134.2±105.5) ng/mL,差异无统计学意义(P>0.05),术后24 h分别为(432.7±151.4) ng/mL和(352.9±135.3) ng/mL,术后1周分别为(338.9±141.7) ng/mL和(297.5±155.7) ng/mL,组间比较差异均有统计学意义(P<0.05),但术后6个月分别为(241.7±103.6) ng/mL和(234.8±98.6) ng/mL,组间比较差异无统计学意义(P>0.05);联合组与单纯PCI组患者无复流或慢血流发生率分别为3.9%和10.1%,CK水平分别为(1 463.4±372.6) U/L和(1 835.1±280.3) U/L,CK-MB水平分别为(163.5±42.9) U/L和(217.2±49.4) U/L,组间比较差异均有统计学意义(P<0.05);联合组与单纯PCI组患者的ST段回落≥50%的患者比例分别为86.1%和61.3%,LVDD分别为(51.5±3.2) mm和(56.1±4.1) mm,LVEF分别为(57.2±3.5)%和(53.3±4.2)%,组间比较差异均有统计学意义(P<0.05);随访6个月,联合组患者的心力衰竭发生率为6.3%,明显低于单纯PCI组的14.4%,差异有统计学意义(P<0.05),而再次心肌梗死、恶性心律失常和心源性死亡发生率比较,差异均无统计学意义(P>0.05)。结论 STEMI患者PCI术中使用血栓抽吸导管可显著减少无复流现象的发生,改善冠脉血流并减轻心肌损伤,这可能与增加血清ITLN-1的表达,进而减少心肌损伤并改善心功能相关。

大腔导管抽吸联合溶栓治疗巴德-吉亚利综合征合并下腔静脉血栓

目的观察大腔导管抽吸术联合置管溶栓及血管成形术治疗巴德-吉亚利综合征(BCS)合并下腔静脉(IVC)血栓的安全性及有效性。方法将74例BCS合并IVC新鲜或以新鲜血栓为主的混合血栓患者分为血栓抽吸组(32例)和单纯溶栓组(42例)。血栓抽吸组接受大腔导管抽吸联合经导管溶栓及血管腔内成形术,单纯溶栓接受行经导管溶栓及血管腔内成形术,比较2组血栓清除效果、溶栓时间、溶栓药用量及并发症。结果2组技术成功率均为100%。血栓抽吸组平均溶栓时间、尿激酶平均用量少于单纯溶栓组(P均<0.05)。血栓抽吸组Ⅲ级血栓清除12例、Ⅱ级19例、Ⅰ级1例,单纯溶栓组分别为17、20及5例,2组差异无统计学意义(P=0.33)。血栓抽吸组2例(2/32,6.25%)、单纯溶栓组3例(3/42,7.14%)出现并发症,组间差异无统计学意义(P=1.00)。结论大腔导管抽吸联合溶栓及血管成形术治疗BCS合并IVC血栓可缩短溶栓时间,减少溶栓药用量,且安全性较好。

Effects of Loading-Dose Statins Combined with PCSK9 Inhibitor Pre-Treatment before Primary Percutaneous Coronary Intervention on the Short-Term Prognosis in Patients with ST-Segment Elevation Myocardial Infarction

Objective:This study was aimed at investigating the effects of preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse events in patients with ST-segment elevation myocardial infarction(STEMI).Method:Sixty-five patients with STEMI who had visited the Shanxi Cardiovascular Disease Hospital between May 2018 and May 2021 were enrolled in the study.The enrolled patients had no history of oral statins or antiplatelet therapy.The patients were divided into a combined treatment group(loading dose of statins combined with PCSK9 inhibitors,35 patients)and a routine treatment group(loading dose of statins only,30 patients).The primary endpoints were thrombolysis in myocardial infarction(TIMI)blood flow grading,corrected TIMI frame count(CTFC),and TIMI myocardial perfusion grading(TMPG),immediately after and 30 days after the operation.The secondary endpoint was a composite endpoint of cardiovascular death,nonfatal myocardial infarction,and target vessel revascularization 30 days after the operation.Results:The combined treatment group had significantly lower CTFC(14.09±8.42 vs 26±12.42,P=0.04)and better TMPG(2.74±0.61 vs 2.5±0.73,P=0.04)than the routine treatment group immediately after the operation.Similarly,the combined treatment group had a significantly lower CTFC(16.29±7.39 vs 26.23±11.53,P=0.04)and significantly better TMPG(2.94±0.24 vs 2.76±0.43,P=0.01)than the routine treatment group 1 month after the operation.Conclusion:Preoperative treatment with a loading dose of high-intensity statins combined with PCSK9 inhibitors increased coronary blood flow and myocardial perfusion after emergency thrombus aspiration in patients with STEMI.However,the treatment did not significantly decrease the incidence of cardiovascular death,nonfatal myocardial infarction,or target vessel revascularization.

Ciliated hepatic foregut cyst with high intra-cystic carbohydrate antigen 19-9 level

A ciliated hepatic foregut cyst (CHFC) is a rare foregut developmental malformation usually diagnosed in adulthood. Five percent of reported cases of CHFC transform into squamous cell carcinoma. We report the presentation, evaluation, and surgical management of a symptomatic 45-year-old male found to have a 6.2 cm CHFC. Contrast tomography-guided fine-needle aspiration demonstrated columnar, ciliated epithelium consistent with the histologic diagnosis of CHFC. The intracystic levels of carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) were extremely high (978118 U/mL and 973 &#x003bc;g/L, respectively). Histologically, the wall of the cyst showed characteristic pseudopapillae lined with a ciliated stratified columnar epithelium, underlying smooth muscle, an outer fibrous layer and no atypia. Immunohistochemistry for CA19-9 and CEA was positive. This is the first case report of a CHFC in which levels of CA 19-9 and CEA were measured. Our findings suggest that a large sized multilocular cyst and elevated cyst CA19-9 and CEA levels do not exclude a CHFC from consideration in the diagnosis. CHFCs should be included in the differential diagnosis of hepatic lesions. Accurate diagnosis of a CHFC is necessary given its potential for malignant transformation, and surgical excision is recommended.

经皮人工血栓抽吸联合利伐沙班对深静脉血栓患者凝血酶调节蛋白、P-选择素的影响

目的探讨经皮人工血栓抽吸联合利伐沙班对深静脉血栓(DVT)患者的治疗效果及对凝血酶调节蛋白(TM)、P-选择素(P-selectin)的影响。方法选取2019年6月至2021年6月保定市第四中心医院收治的110例DVT患者,按随机数字表法分为观察组和对照组,每组55例。比较两组患者的临床疗效、凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]、血小板参数[血小板计数(PLT)、血小板分布宽度(PDW)、平均血小板体积(MPV)]水平、血清学指标[凝血酶调节蛋白(TM)、P-选择素、血栓前体蛋白(TpP)]水平及不良反应发生情况。结果观察组患者的总有效率高于对照组患者,差异有统计学意义(P﹤0.05)。治疗后,两组患者的PT、TT、APTT均长于本组治疗前,FIB水平低于本组治疗前,且观察组患者的PT、TT、APTT均长于对照组患者,FIB水平低于对照组患者,差异均有统计学意义(P﹤0.05)。治疗后,两组患者的PLT、PDW、MPV水平均低于本组治疗前,且观察组患者的上述指标水平均低于对照组患者,差异均有统计学意义(P﹤0.05)。治疗后,两组患者的TM、P-选择素、TpP水平均低于本组治疗前,且观察组患者的上述指标水平均低于对照组患者,差异均有统计学意义(P﹤0.05)。治疗期间,两组患者的不良反应总发生率比较,差异无统计学意义(P﹥0.05)。结论经皮人工血栓抽吸联合利伐沙班对DVT患者的溶栓效果显著,能够改善患者的凝血功能和血小板参数水平,降低血清学指标水平,安全性较高,可临床推广。