延期支架置入对高血栓负荷ST段抬高急性心肌梗死预后的影响

目的研究高血栓负荷的ST段抬高急性心肌梗死（STEMI）患者血栓抽吸后,延迟置入支架对患者预后的影响。方法选取129例血栓积分评分≥2分,经皮冠状动脉球囊扩张成形术（PTCA）和（或）血栓抽吸后血栓积分评分≤2分的STEMI患者纳入本研究,随机分为即时支架组（65例）和延期支架组（64例）。结果两组患者支架置入后TIMI积分、术后2 h ST段回落≥50%比较,差异均无统计学意义;而TIMI心肌灌注分级（TMP）积分即刻支架组显著低于延期支架组,差异有统计学意义（P〈0.001）。延期支架组术后6个月较入院时左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）降低,左心室射血分数（LVEF）升高,其中LVEDV降低差异有统计学意义（P〈0.05）;即时支架组6个月后较入院时LVEDV、LVESV升高,LVEF降低,其中LVESV升高（P〈0.05）和LVEF降低（P〈0.001）差异有统计学意义。术后30 d内两组间主要不良心血管事件（MACE）及主要出血事件比较,差异均无统计学意义。术后12个月时,两组心源性死亡、再发心肌梗死、靶血管血运重建比较,差异均无统计学意义（P〈0.05）,但即时支架组心力衰竭发生率较延期支架组显著增多（P〈0.05）,使得即时支架组MACE事件发生率较延期支架组显著升高（P〈0.05）。两组间比较,延期支架组住院天数较即时支架组增多,差异有显著统计学意义（P〈0.001）,且住院费用显著增多,差异有显著统计学意义（P〈0.001）。结论对于高血栓负荷的STEMI患者,经PTCA、血栓抽吸、强化抗栓处理后延迟行支架置入,可更好地改善患者的心肌灌注,减少心力衰竭的发生,从而使MACE事件发生率下降,但延期支架置入术患者的住院天数和住院费用会相应增加。

Outcomes of delayed stent implantation in ST segment elevation acute myocardial infarction with high thrombus burden

Objective To examine the outcomes of delayed stent implantation in patients with ST segment elevation acute myocardial infarction（ STEMI） with high thrombus burden after thrombus extraction was performed. Methods 129 STEMI patients were included according to thrombus score（ TS） ≥2,and the thrombus score ≤2 after percutaneous transtumina coronary angioplasty（ PTCA） or thrombus extraction was performed,then they were divided into 2 groups based on the immediate stent implantation group and the delayed stent implantation group. Results There were no significant difference of TIMI flow grade and ST segment recovery at 2 hours after percutaneous coronary intervention. However,TIMI myocardial perfusion（ TMP） score in the immediate stent implantation group was significantly lower than that in the delayed stent implantation group（ P 〈 0. 001）. After 6 months,measurements of left ventricular end-diastolic volume（ LVEDV） and left ventricular end-systolic volume（ LVESV） were decreased while left ventricular ejection fraction（ LVEF） was increased in the delayed stent implantation group. In the immediate stent implantation group,LVEDV,LVESV were increased（ P 〈 0. 05）,but LVEF decreased（ P 〈 0. 001）. After 12 months,there were no significant difference in death,re-infarction or repeat revascularization,but there were more heart failure patients in the immediate stent implantation group than in the delayed stent implantation group（ P 〈 0. 05）. There were more main adverse cardiac events（ MACE） in the immediate stent implantation group（ P 〈 0. 05）. Compare to the immediate stent implantation group,the length of hospital stay was longer in the delayed stent implantation group（ P 〈 0. 001）,and the average hospital expenditure was higher in the delayed stent implantation group（ P 〈 0. 001）. Conclusions Delayed stent implantation can improve myocardial perfusion in STEMI patients with high thrombus burden after PTCA or thrombus extraction and intensive ant