不同措施干预心肌梗死患者PCI术中无复流现象的远期疗效

目的研究不同干预措施对ST段抬高心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)中无复流现象的远期疗效。方法入选接受过PCI术无复流预防及治疗措施且有完整随访资料的127例STEMI患者,其中PCI术前采用Diver CE血栓抽吸导管患者34例(抽吸预防组),冠状动脉内及静脉应用替罗非班患者34例(替罗非班预防组),PCI术中发生无复流现象的患者中应用替罗非班18例(替罗非班治疗组),应用替罗非班+血塞通18例(替罗非班+血塞通组),应用腺苷11例(腺苷组),应用维拉帕米12例(维拉帕米组)。随访及分析患者18个月及36个月时发生心绞痛再发、心肌梗死再发、心力衰竭、心源性死亡等主要心脏不良事件(MACE)。结果抽吸预防组、替罗非班预防组、替罗非班治疗组、替罗非班+血塞通组、腺苷组、维拉帕米组六组127例患者随访18个月时,心力衰竭发生率分别为5.9%、17.6%、33.3%、27.8%、45.4%、50.0%;MACE发生率分别为8.8%、29.4%、50.0%、38.9%、63.6%、66.7%。抽吸预防组心力衰竭发生率和MACE发生率最低,与其他各组比较有统计学差异(P0.05);替罗非班预防组心力衰竭发生率和总体MACEs发生率低于腺苷组和维拉帕米组,差异有统计学意义(P0.05);替罗非班治疗组、替罗非班+血塞通治疗组、腺苷组和维拉帕米组四组47例患者随访36个月时,各组间MACEs发生率无统计学差异(P0.05)。结论冠状动脉内血栓负荷重的STEMI患者,PCI术前应用血栓抽吸导管有较好的远期疗效;替罗非班、替罗非班联用血塞通、腺苷、维拉帕米几种药物治疗无复流现象远期疗效相似。

Long-term curative effect of different intervention therapies on non-reflow in patients with myocardial infarction during PCI

Objective To study the long-term curative effect of different intervention therapies on non-reflow in patients with ST-segment elevation myocardial infarction （STEMI） during PCI. Methods The patients （n=127） accepted the preventive therapies during PCI and with complete follow-up materials were divided into aspiration group （intervened with Diver CE thrombus aspiration catheter, n=34）, tirofiban prevention group （with tirofiban in coronary artery and vein, n=34）, tirofiban treatment group （intervened with non-reflow and treated with tirofiban, n=18）, tirofiban＋Xuesaitong group （treated with tirofiban and Xuesaitong, n=18）, adenosine group （treated with adenosine, n=11） and verapamil group （treated with verapamil, n=12）. The incidences of relapsed angina, relapsed myocardial infarction, heart failure, cardiac death and major adverse cardiovascular events （MACE） were followed up and analyzed on the 18th month and 36th month respectively. Results On the 18th month, the incidence of heart failure was, respectively, 5.9%, 17.6%, 33.3%, 27.8%, 45.4%and 50.0%in 6 groups, and that of MACE, 8.8%, 29.4%, 50.0%, 38.9%, 63.6%and 66.7%. The incidences of heart failure and MACE were the lowest in aspiration group compared with other groups （P〈0.05）, and were lower in tirofiban prevention group than those in adenosine group and verapamil group （P〈0.05）. After followed up for 36 months, the incidence of MACE had no statistical difference among tirofiban treatment group, tirofiban＋Xuesaitong group, adenosine group and verapamil group （P〈0.05）. Conclusion The thrombus aspiration catheter used before PCI has good long-term curative effect in the STEMI patients with heavy thrombus load. The long-term curative effects of tirofiban, tirofiban＋Xuesaitong, adenosine and verapamil are similar in the treatment of non-reflow.