急性ST段抬高型心肌梗死急诊介入治疗中应用血栓抽吸器的临床研究

目的:评价在急性ST段抬高型心肌梗死(STEMI)急诊介入治疗中应用血栓抽吸器的安全性和有效性。方法:选择2005年7月至2006年10月在我中心接受急诊经皮冠状动脉介入治疗的STEMI患者,使用血栓抽吸器者为抽吸器组(n=33),根据冠状动脉造影及临床情况从同期STEMI患者中选取条件相当者作为对照组(n=33),比较两组间的基础资料、术后即刻冠状动脉造影结果以及住院和随访期间情况。结果:两组间基础临床资料相似、抽吸器组支架直接置入率高、远端栓塞发生率低、校正的心肌梗死溶栓治疗临床试验帧数计数(cTFC)值小、心肌灌注分级3级获得率高,住院期间抽吸器组肌酸激酶MB同工酶和肌钙蛋白T峰值浓度较低,术后12小时心电图ST段回落幅度大,均显著优于对照组(P均<0.05～0.01);但两组间无/慢血流、术后心肌梗死溶栓治疗临床试验(TIMI)3级及两组住院期间主要心血管病事件发生情况未显示出统计学差异。结论:在血栓负荷较重的STEMI患者急诊介入治疗时,应用血栓抽吸器安全可行,可显著改善患者术后即刻的远端心肌组织微灌注,减少心肌酶的释放,但远期疗效还需进一步评价。     

The obesity paradox in ST-segment elevation myocardial infarction patients: A meta-analysis

Objective

The aim of this study was to investigate whether there was a difference in survival after initial percutaneous coronary intervention (PCI) among ST-segment elevation myocardial infarction (STEMI) patients with different body mass index (BMI).

Methods

Literature retrieval was conducted on PubMed, Web of Science, Embase, CNKI, and Wanfang databases to obtain the published studies on the survival of STEMI patients with different BMI after initial PCI from the establishment of the database to 2022. All statistical analyses were performed using STATA16.0.

Results

Two hundred thirty-nine studies were retrieved, and 12 studies were eventually included. Meta-analysis showed that overweight patients [OR = 0.66, 95% CI (0.58, 0.76), p < .001] and obese patients [OR = 0.60, 95% CI (0.51, 0.72), p < .001] had lower in-hospital mortality than healthy-weight patients. Overweight patients [OR = 0.66, 95% CI (0.58, 0.74), p < .001] and obese patients [OR = 0.62, 95% CI (0.53, 0.72), p < .001] had lower short-term mortality than healthy-weight patients. In addition, overweight patients [OR = 0.63, 95% CI (0.58, 0.69), p < .001] and obese patients [OR = 0.59, 95% CI (0.52, 0.66), p < .001] also had lower long-term mortality than healthy-weight patients. There was no significant difference in in-hospital mortality [OR = 1.06, 95% CI (0.89, 1.27), p > .05], short-term mortality [OR = 1.04, 95% CI (0.89, 1.22), p > .05], and long-term mortality [OR = 1.07, 95% CI (0.95, 1.20), p > .05] between overweight and obese patients.

Conclusion

This meta-analysis confirmed an obesity paradox in STEMI patients following PCI. The obesity paradox exists in in-hospital, short-term, and long-term conditions.     

Effects of aspiration thrombectomy on necrosis size and ejection fraction after transradial percutaneous coronary intervention in acute ST‐elevation myocardial infarction

Background: The use of routine aspiration thrombectomy in primary percutaneous coronary intervention (PCI) remains controversial. Methods: Patients in the EArly Discharge after Transradial Stenting of CoronarY Arteries in Acute Myocardial Infarction (n = 105) study were treated with aspirin, clopidogrel, and abciximab within 6 hr of symptoms onset. Operators were allowed to use 6 Fr Export aspiration catheter at their discretion. In this observational analysis, we compared acute and late results in patients treated with and without thrombectomy using cardiac biomarkers, angiographic, cardiovascular magnetic resonance (CMR), and clinical parameters. Results. Patients in the thrombectomy group (n = 44) had longer symptoms to balloon time (196 ± 86 min vs. 164 ± 62, P = 0.039) and higher incidence of preprocedural TIMI flow grade 0 or 1 (84% vs. 64%, P = 0.028). Following PCI, both groups had similar incidence of TIMI flow grade 3 (93 vs. 92%, P = 0.73) and myocardial blush grade 2 or 3 (80 vs. 77%, P = 0.86), respectively. Patients in thrombectomy group had significantly higher post‐PCI maximum values of creatine kinase‐MB (P = 0.0007) and troponin T (P = 0.0010). Accordingly, post‐PCI myocardial necrosis by CMR was higher (P = 0.0030) in patients in the thrombectomy group. At 6‐month follow‐up, necrosis size remained higher (20.7% ± 13.3% vs. 13.5% ± 11.1%, P = 0.012) in the thrombectomy group. Ejection fraction at 6 months was 65% ± 9% in patients in thrombectomy group compared to 70% ± 11% in patients without (P = 0.070). Results were not affected by initial TIMI flow or symptoms to balloon time. Clinical events remained comparable in both groups at 12 months follow‐up. Conclusion: In patients with ST‐segment elevation myocardial infarction presenting within 6 hr of symptoms and undergoing primary angioplasty with maximal antiplatelet therapy, acute and late results did not suggest significant benefit for additional aspiration thrombectomy, irrespective of initial TIMI flow or total ischemic time. © 2010 Wiley‐Liss, Inc.     

Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Background and aimsDespite elevated serum uric acid (eSUA) has been identified as independent risk factor for cardiovascular diseases, its prognostic value in the setting of ST-segment elevation myocardial infarction (STEMI) is still controversial. Although the mechanisms of this possible relationship are unsettled it has been suggested that eSUA could trigger the inflammatory response. This study sought to investigate the association between eSUA with short- and long-term mortality and with inflammatory response in patients with STEMI treated with primary percutaneous coronary intervention (pPCI).Methods and resultsBlood samples were collected on admission and at 24 and 48 h after pPCI: the inflammatory biomarkers C-reactive protein (CRP), neutrophil count and neutrophil to lymphocytes ratio (NLR) were considered. Baseline eSUA was defined as ≥6.8 mg/dl. Cumulative 30-days and 1-year mortalities were estimated using the Kaplan-Meyer analysis. Multivariable analyses were performed by Cox proportional hazard models.In the 2369 patients with STEMI considered, 30-day mortality was 5.8% among patients with eSUA and 2% among patient with normal SUA level (p < 0.001); 1-year mortality was 8.5% vs 4%, respectively (p < 0.001). At multivariable analyses eSUA was an independent predictor of 30-day mortality (HR 1.196, 95%CI 1.006–1.321, p = 0.042) and 1-year mortality (HR 1.178, 95%CI 1.052–1.320, p = 0.005). eSUA patients presented higher values in on admission CRP (p < 0.001) and in neutrophil count and NLR at 24 h (respectively, p = 0.020 and p < 0.001) and at 48 h (p = 0.018 and p < 0.001) compared to patients with normal SUA levels.ConclusionsElevated serum uric acid is associated with higher short- and long-term mortality and with a greater inflammatory response after reperfusion in patients with STEMI treated with primary PCI.     

The effect of thrombectomy on myocardial blush in primary angioplasty: The randomized evaluation of thrombus aspiration by two thrombectomy devices in acute myocardial infarction (RETAMI) trial

Background: In patients with ST‐segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) may cause thrombus dislodgment leading to microvascular function impairment, which is a negative independent predictor of myocardial function recovery. Compared with conventional stenting, pretreatment with aspiration thrombectomy during primary PCI significantly improves coronary epicardial flow and myocardial tissue perfusion parameters. We sought to evaluate the angiographic findings of two different manual aspiration thrombectomy devices (Diver‐Invatec® (DI) and Export‐Medtronic®® (EM)) in STEMI patients undergoing primary angioplasty. Methods: We randomized 103 STEMI patients referred to our hospital to undergo primary PCI (<12 hr from symptoms onset) to DI (n = 52) and EM (n = 51) devices. The primary angiographic composite end‐points were the rates of post‐thrombectomy thrombus score (TS) ≤≤2, TIMI flow grade ≥≥2, and post‐stenting myocardial blush grade (MBG) ≥≥2 in the two groups. Results: Baseline, clinical, and angiographic preprocedural findings did not differ between the two groups. After aspiration thrombectomy, a TS ≤≤ 2 was more frequently present in EM group (92.3 vs. 69.3%, P = 0.0052). Also the rate of post‐thrombectomy TIMI ≥≥ 2 (69.3 vs. 92.2%, P = 0.0052) and post‐stenting MBG ≥≥2 (88.2 vs. 69.3%, P = 0.029) were significantly higher in EM group. No significative differences were observed in terms of clinical events at 1 and 12 months. Conclusions: In this single‐center, prospective, randomized study, a EM use before stenting in STEMI patients seems to remove more thrombotic burden compared with DI, providing a greater post‐thrombectomy epicardial flow and a better post‐stenting microvascular perfusion. © 2008 Wiley‐Liss, Inc.     

Stenting after thrombectomy with the AngioJet™ catheter for acute myocardial infarction

The presence of massive intracoronary thrombi may contraindicate stenting. The AngioJet™ catheter rheolytic thrombectomy prepared the road for an easy and uneventful stenting in 2 patients with acute myocardial infarction (AMI) and thrombi. This combination provides a promising strategy for patients with AMI and angiographic evidence of massive thrombi. Cathet. Cardiovasc. Diagn. 43:327–330, 1998. © 1998 Wiley-Liss, Inc.     

急性ST段抬高型心肌梗死患者溶栓后经皮冠状动脉介入治疗时机的选择

目的:探讨急性心肌梗死静脉溶栓后紧急转诊经皮冠状动脉介入治疗(PCI)模式的科学性、有效性及安全性。方法:5例急性ST段抬高型心肌梗死(STEMI)患者在外院行静脉溶栓后经绿色通道直接送至我院心导管室行紧急PCI术,观察转运途中的安全性、术中及术后的并发症,术后即刻疗效及出院后短期随访效果。结果:溶栓后立即转诊至我院并紧急PCI的5例患者均顺利完成PCI术,住院期间未见再发缺血事件,也未见明显出血并发症,缩短了患者的住院时间,术后短期随访未见明显不良事件发生。结论:在具备抢救设备及医护人员陪同的条件下,外院STEMI患者溶栓后立即转诊实施紧急PCI术是安全的,且对患者有益,手术时间应在溶栓3h之后,根据术中情况决定术后抗血小板聚集和抗凝治疗。     

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.     

血栓抽吸导管对急性心肌梗死患者心肌灌注水平影响的临床研究

目的分析在血栓负荷较大的急性心肌梗死(AMI)患者行急诊PCI中,应用抽吸导管对心肌再灌注的影响及安全性。方法选择经急诊冠状动脉造影显示血栓负荷较大的AMI患者36例作为血栓抽吸组,另选同期采用常规PCI的AMI患者36例作为对照组,比较2组的血栓负荷、TIMI分级、TIMI心肌灌注(TMP)分级、心肌酶峰值、ST段回落幅度、LVEF、住院期间心血管不良事件。结果血栓抽吸组患者经抽吸后血栓负荷明显降低;血栓抽吸组患者TIMI分级和TMP分级明显优于对照组,差异有统计学意义(P0.01);血栓抽吸组患者较对照组肌酸激酶、肌酸激酶同工酶峰值明显降低,术后1 h ST段回落百分比明显增高,LVEF明显升高,左心室舒张末内径明显下降,差异有统计学意义(P0.01)。结论在血栓负荷较重的AMI患者行急诊PCI时,应用血栓抽吸导管安全可行,可显著改善梗死相关血管前向血流情况,改善心肌再灌注,减少无复流现象和心肌酶的释放。     

Gender differences in clinical outcomes of acute myocardial infarction undergoing percutaneous coronary intervention: insights from the KAMIR-NIH Registry

BackgroundThere are numerous but conflicting data regarding gender differences in outcomes following percutaneous coronary intervention (PCI). Furthermore, gender differences in clinical outcomes with acute myocardial infarction (AMI) following PCI in Asian population remain uncertain because of the under-representation of Asian in previous trials.MethodsA total of 13, 104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015 were classified into male (n = 8021, 75.9%) and female (n = 2547, 24.1%). We compared the demographic, clinical and angiographic characteristics, 30-days and 1-year major adverse cardiac and cerebrovascular events (MACCE) in women with those in men after AMI by using propensity score (PS) matching.ResultsCompared with men, women were older, had more comorbidities and more often presented with non-ST segment elevation myocardial infarction (NSTEMI) and reduced left ventricular systolic function. Over the median follow-up of 363 days, gender differences in both 30-days and 1-year MACCE as well as thrombolysis in myocardial infarction minor bleeding risk were not observed in the PS matched population (30-days MACCE: 5.3% vs. 4.7%, log-rank P = 0.494, HR = 1.126, 95% CI: 0.800-1.585; 1-year MACCE: 9.3% vs. 9.0%, log-rank P = 0.803, HR = 1.032, 95% CI: 0.802-1.328; TIMI minor bleeding: 4.9% vs. 3.9%, log-rank P= 0.215, HR = 1.255, 95% CI: 0.869-1.814).ConclusionsAmong Korean AMI population undergoing contemporary PCI, women, as compared with men, had different clinical and angiographic characteristics but showed similar 30-days and 1-year clinical outcomes. The risk of bleeding after PCI was comparable between men and women during one-year follow up.     

Examination of the appropriate timing of reperfusion therapy for recent myocardial infarction: a Japanese single-center retrospective study

BackgroundThe various guidelines clearly mention the treatment strategies for in patient of acute myocardial infarction (MI) presenting more than 24 h from symptom onset (recent myocardial infarction, RMI). However, the appropriate timing of reperfusion for RMI is unclear.MethodsWe retrospectively evaluated 525 consecutive MI patients who underwent percutaneous coronary intervention (PCI) in our hospital between January 2008 and December 2012.ResultsSixty RMI patients were more frequently associated with cardiac complications such as myocardial rupture (3.3% vs. 0%; p < 0.01), ventricular septal rupture (3.3% vs. 0.4%; p < 0.05), and congestive heart failure (15% vs. 2.6%; p < 0.001) than 272 consecutive ST-elevation myocardial infarction (STEMI) patients. Of the 60 RMI patients, 33 (55.0%) underwent PCI within 7 days (early-PCI group) and 27 (45.0%) underwent PCI after 7 days (late-PCI group). Left ventricular ejection fraction measured by echocardiography at second hospital day was similar between the groups. The early-PCI group was more significantly associated with cardiogenic shock and heart failure and more frequently required intra-aortic balloon pumping (24.2% vs. 3.7%; p < 0.05) than the late-PCI group. There were no significant differences in 30-day mortality, cardiac complications, and major cardiac events during long-term follow-up (12–36 months) between the groups.ConclusionRMI patients had a higher incidence of cardiac complications than AMI patients. Clinical outcomes were similar between patients undergoing early revascularization and those undergoing late revascularization, although the former group included a higher proportion of patients with severe cardiac failure.     

在院发生与新入院急性心肌梗死的对比分析

目的 对比在院发生急性心肌梗死（AMI）与新入院AMI患者的发病、治疗及预后特点.方法 记录2013年1月至2014年1月中国人民解放军第422医院AMI患者的发病、治疗及预后信息,根据是否为住院期间发生的AMI,分为在院组和新入院组,对比两组基线资料、治疗和预后指标,分析其相关因素.结果 共纳入105例患者,新入院组90例,在院组15例,在院与新入院发生AMI患者的年龄、性别、高血压、糖尿病、高脂血症等比较,差异均无统计学意义（P＞0.05）.在院组患者重要脏器受累较新入院组多（P＜0.001）,其中基础呼吸系统疾病、脑疾病和运动功能不全比较,差异均有统计学意义（P＜0.05）.在院组患者严重电解质紊乱7例（46.7％）,新入院组21例（23.3％）,差异无统计学意义（P=0.058）.在院组患者死亡7例（46.7％）,新入院组死亡6例（6.7％）,差异有统计学意义（P＜0.001）.在院组行经皮冠状动脉介入治疗（PCI）的患者2例（13.3％）,新入院组42例（46.7％）,差异有统计学意义（P=0.027）,症状发作时间过长和家属拒绝为主要原因.结论 与新入院AMI比较,在院患者发生AMI预后差,死亡率高,可能与衰竭器官多、对介入治疗态度消极相关.     

急性ST段抬高心肌梗死患者急诊经皮冠状动脉介入治疗无复流现象相关因素分析

目的探讨急性ST段抬高心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）中出现无复流的相关危险因素。方法选取发病在12h内的1059例STEMI患者给予急诊PCI,收集患者的临床、造影和介入治疗资料。PCI术后,根据心肌梗死溶栓（TIMI）分级和校正TIMI帧数将患者分为正常血流组和无复流组。比较两组患者的基本临床资料、造影结果和手术相关资料的差异,分析STEMI患者急诊PCI术中出现无复流的原因。结果急诊PCI术中无复流组患者118例。正常血流组941例,无复流发生率为11．14％。研究共纳入63个指标,通过单变量分析发现,年龄、症状至PCI时间、谷草转氨酶、氯吡格雷使用情况、干预病变数、狭窄程度及血栓负荷与急诊PCI术中发生无复流具有相关性（P〈0．05）。多变量Logistic回归模型认为,年龄（OR=1．04,95％CI：1．02—1．06）与血栓负荷（OR=1．72,95％CI：1．07～2．76）可作为预测急诊PCI术中无复流发生的独立危险因素。结论年龄与血栓负荷可作为预测急性STEMI患者急诊PCI术中发生无复流的独立危险因素,而糖尿病、高血压、高血脂、吸烟等冠心病的传统危险因素与无复流未见相关性。     

胸痛中心认证对急性ST段抬高型心肌梗死患者救治效率的影响

目的观察我院胸痛中心认证前后急性ST段抬高型心肌梗死(STEMI)救治关键指标的变化。方法采取回顾性非同期队列研究方式,以我院通过中国胸痛中心联盟正式认证时间为划分时间点,将2017年9月至2018年9月收治的STEMI患者为胸痛中心认证前组(206例),将2018年10月至2019年10月收治的STEMI患者为胸痛中心认证后组(284例)。比较胸痛中心认证前后STEMI患者院前救治、院内救治关键指标的变化以及住院期间死亡率、住院时间和住院费用的差异。结果胸痛中心认证后组心电图(ECG)远程传输比例[122(43.0%)比62(30.1%),P=0.008]和绕行急诊科或CCU比例[117(41.2%)比64(31.1%),P=0.022]与胸痛中心认证前组比较显著增加,首次医疗接触至完成首份ECG(FMC-to-ECG)[3(2,5)min比5(2,7)min,P<0.001]与胸痛中心认证前组比较显著缩短,差异均有统计学意义;两组患者发病至首次医疗接触(S-to-FMC)时间比较,差异无统计学意义(P=0.146)。胸痛中心认证后组ECG至确诊时间[(76.3±57.9)min比(92.0±65.8)min,P=0.040]较胸痛中心认证前组显著下降;胸痛中心认证后组进入医院大门至球囊扩张(D-to-B)时间[76.0(60.0,88.0)min比94.0(78.0,195.0)min,P<0.001]和首次医疗接触至球囊扩张(FMC-to-B)时间[(96.1±67.3)min比(112.4±84.0)min,P=0.022]均较胸痛中心认证前组显著下降,差异均有统计学意义。胸痛中心认证后组D-to-B时间<90 min达标率[201(70.8%)比119(57.8%),P=0.003]和FMC-to-B<120 min达标率[180(63.4%)比101(49.0%),P=0.002]均较胸痛中心认证前组显著增加,差异均有统计学意义。胸痛中心认证后组院内死亡率与胸痛中心认证前组比较,有下降趋势[11(3.9%)比10(4.9%),P=0.654],但差异无统计学意义。胸痛中心认证前后组患者住院时间和住院总费用比较,差异均无统计学意义(均P>0.05)。结论我院胸痛中心认证后较认证前显著缩短了STEMI救治时间,尤其是D-to-B时间,有助于提高胸痛中心STEMI患者的救治效率。     

经皮冠状动脉介入术联合经皮血栓吸除术治疗急性心肌梗死的临床评价

目的 评价经皮冠状动脉介入术(PCI)联合经皮血栓吸除术治疗急性心肌梗死(AMI)的疗效.方法 56例AMI患者随机分为PCI组(n=28)和PCI联合血栓吸除术组(n=28).于PCI术后24小时、1周行实时心肌声学造影(RT-MCE),记录各组灌注对比积分指数(CSI)、室壁运动积分指数(WMSI)、透壁性对比缺损长度(CDL)和严重室壁运动异常长度(WML).采用免疫散射比浊法测定血浆超敏C-反应蛋白(hs-CRP)水平,酶联免疫吸附法测定血浆N-末端脑利钠肽(NT-ProBNP)和基质金属蛋白酶-9(MMP-9)水平.结果 各时间点PCI联合血栓吸除术组CSI、WMSI、CDL和WML明显低于PCI组(P＜0.05).术后1周PCI联合血栓吸除术组血浆hs-CPR和NT-ProBNP水平低于对照组[(4.56±1.98)mg/L比(5.96±2.03)mg/L,P＜0.05;(544.7±185.3)pmol/L比(897.6±215.9)pmol/L,P＜0.01],血浆MMP-9无明显升高[(672.7±175.9)μg/L比(609.6±196.5)μg/L,P＞0.05].结论 与PCI组相比,PCI联合经皮血栓吸除术可明显减少术后无再流的发生,改善微循环和心脏功能,是治疗AMI的有效方法.     

急性ST段抬高型心肌梗死尿激酶原溶栓后早期介入与直接介入治疗的研究

目的：比较急性ST段抬高心肌梗死(STEMI)重组人尿激酶原溶栓后早期经皮冠状动脉介入治疗( PCI) 与直接PCI的疗效。方法：2014年1月－2015年6月就诊于我院STEMI患者69例,根据治疗方法将患者分为尿激酶原溶栓后早期PCI组和直接PCI组,分别对两组患者梗死相关动脉( IRA) 的再通率、并发症发生率、支架植入术、住院期间死亡率及1 个月后患者左室射血分数( LVEF) 等指标进行比较分析。结果：溶栓后早期PCI组共纳入32例患者,直接PCI组共纳入37例患者。术前溶栓后早期介入组血管开通率87.5%(18.7%TIMI Ⅱ级, 68.8%TIMI Ⅲ 级血流), 直接PCI组为18.9%(10.8%为TIMI Ⅱ级血流, 8.1%TIMI Ⅲ 级血流)(P <0.001)。两组PCI术后血流再通率相似, 分别为90.6%、89.8 %(P=0.653),但尿激酶原溶栓早期PCI组所用支架数更少。两组住院期间不良事件发生率(大出血、在闭塞、急性型左心衰和住院天数)无显著差异。1月后随访LVEF、LVEDd、心源性死亡、再梗、脑卒中等无显著差异。结论：尿激酶原溶栓后早期PCI治疗是一种有效、安全的替代再灌注策略。     

冠脉内小剂量替罗非班联合血栓抽吸治疗急性ST段抬高型心肌梗死疗效观察

目的 评价冠脉及静脉内小剂量注射替罗非班联合冠脉内血栓抽吸对急性ST段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入（PCI）梗死相关血管血流及预后的影响.方法 选择诊断为STEMI、接受直接PCI治疗患者133例,随机分为冠脉及静脉内注射小剂量血小板膜糖蛋白Ⅱb/Ⅲa（GPⅡb/Ⅲa）受体拮抗剂替罗非班联合冠脉内血栓抽吸组（治疗组,67例）和常规PCI联合静脉内大剂量替罗非班组（对照组,66例）.评估两组PCI前后梗死相关血管TIMI血流分级、心肌灌注情况、术后90天主要心血管事件（MACE）及术后出血情况.结果 两组血管开通率均为100%,与对照组比较,治疗组无复流减少,心肌灌注情况改善、90天MACE下降（2.9% vs.12.1%,P＜0.05）.而围术期出血发生率无明显差异.结论 冠脉及静脉内小剂量注射替罗非班联合血栓抽吸可有效改善STEMI患者梗死相关血管的血流,改善患者预后,并具有较好的安全性.     

胸痛中心区域协同救治体系对ST段抬高型心肌梗死再灌注时间和预后的影响

目的观察胸痛中心(CPC)区域协同救治体系对急性ST段抬高型心肌梗死(STEMI)再灌注时间和预后的影响。方法选择直接经皮冠状动脉介入治疗(PCI)的STEMI患者,根据是否纳入胸痛中心区域协同救治体系分为区域协同救治组(160例)和CPC成立前组(92例),比较两组患者首次医疗接触至球囊扩张(FMC-to-B)时间、入门至球囊扩张(D-to-B)时间和FMC-to-B时间<120 min、D-to-B时间<90 min达标率以及住院期间主要并发症;对患者随访6个月,比较两组患者左心室射血分数(LVEF)和主要不良心血管事件(MACE)发生率。结果区域协同救治组FMC-to-B时间[(112.8±87.0)min比(154.5±64.1)min,P=0.022]、D-to-B时间[(84.5±47.6)min比(136.3±62.4)min,P=0.019]较CPC成立前组显著下降;而FMC-to-B时间<120 min达标率(69.6%比48.4%,P<0.001)和D-to-B时间<90 min达标率(82.7%比36.5%,P<0.001)较CPC成立前组显著增加,差异均有统计学意义。区域协同救治组患者LVEF[(58.7±3.5)%比(53.0±4.2)%,P=0.040]大于CPC成立前组,而MACE发生率(6.0%比12.7%,P=0.044)较CPC成立前组显著下降,差异均有统计学意义。结论CPC区域协同救治体系有效缩短STEMI患者再灌注时间,减少住院期间主要并发症和改善患者预后。