ST段抬高的急性心肌梗死急诊介入治疗后单导联ST段回落不良对预后的影响及其预测因素

目的探讨单个导联ST段回落程度不良对临床预后的影响并筛选其相关的预测因素,以早期识别高危患者,从而积极防止心肌无复流的发生。方法回顾性收集964例急性ST段抬高心肌梗死行急诊PCI患者的临床资料、冠状动脉造影资料与心电图,分析单导联ST段回落不良患者的临床特征及住院期间主要不良心脏事件（MACE）发生的差异,应用统计学软件筛选盯段回落不良的预测因素。结果急诊PCI后梗死相关血管（IRA）前向血流达到TIMIⅢ级而心电图ST段回落小于50％者占27．42％。ST段无回落组其年龄更大、前壁心肌梗死比率更多、心功能分级≥Killip2级更多、肌酸激酶同工酶（CK-MB）峰值更高、糖尿病比率更多、纤维蛋白原浓度更大、C反应蛋白（CRP）升高比率更多、入院白细胞水平更高、胸痛至急诊室时间更长、冠状动脉病变更复杂,临床预后比较显示,汀段无回落组平均住院日更长,左室射血分数更低,梗死后心绞痛发生率更高,术后IRA血流TIMIⅢ级达标率更低,心力衰竭、恶性心律失常、心脏性死亡以及总的MACE事件发生率更高（25．5％对4．4％,P〈0．001）。Cox回归分析显示ST段回落不良是住院期间发生MACE的独立预测因素之一（RR=3．33,P〈0．001）。Logistic回归分析显示ST段回落不良的预测因素有前壁心肌梗死、入院心功能分级2级以上（Killip）、胸痛至急诊室时间（h）、入院白细胞计数。结论ST段抬高的心肌梗死急诊PCI后IRA达到TIMIⅢ级血流者仍会有近1／3的患者其心电图ST段回落小于50％,反映其心肌组织水平灌注不良,这些患者住院期间发生MACE的风险明显升高。前壁心肌梗死、入院心功能较差、入院白细胞计数较高、胸痛至急诊室时间较长等均与ST段回落不良高度相关,对具备以上情况的高危患者应采取更加积极的干预方案。     

急性ST段抬高性心肌梗死急诊介入治疗后单导联ST段回落不良对预后的影响

目的探讨急性ST段抬高性心肌梗死（STEMI）急诊介入治疗后单导联ST段回落程度对预后的影响。方法回顾性分析248例急性STEMI行急诊PCI治疗患者的临床资料,将患者分为两组,A组为ST段回落良好组（回落率950％）,B组为ST段回落不良组（回落率〈50％）。比较两组的预后情况。结果A组172例（69．40％）,B组76例（30．60％）。随访2年,B组发生主要心脏不良事件（MACE）的比例高于A组,B组在随访期间发生MACE的相对危险度（RR值）为42．48（P〈0．05）。结论急性STEMI急诊介入治疗后ST段回落程度与临床预后显著相关。     

疏血通注射液对STEMI患者直接PCI术心肌灌注和临床预后的影响

目的 探讨应用疏血通注射液对ST段抬高型急性心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）术后心肌灌注和临床预后的影响。方法 80例行直接PCI的STEMI患者随机分为疏血通组（40例）和替罗非班组（40例）,比较两组基础临床情况、介入治疗结果、术后30 min ST段回落情况、出血事件、住院期间左室射血分数(LVEF)及6个月内主要心脏不良事件(MACE)（死亡、再次心肌梗死、靶血管的再次血运重建、严重心力衰竭）。结果 共有79例完成试验,两组术前血管开通率、术后TIMI血流、校正的TIMI血流帧数（CTFC）、术后30 min ST段回落>50%的获得率、出血事件、住院和随访期间MACE的发生率均无明显差异。疏血通组和替罗非班组在住院期间各有1例死亡,在6个月随访期间疏血通组有1例死亡,1例复发心肌梗死,替罗非班组有1例行冠状动脉旁路移植术。结论 疏血通注射液联合STEMI直接PCI术在改善PCI术后的心肌灌注和患者的临床预后方面与替罗非班无显著差异。     

急性ST段抬高型心肌梗死病人介入治疗与溶栓治疗的心电图对比分析

目的 探讨急性ST段抬高型心肌梗死的病人采用急诊介入治疗（PCI）与溶栓治疗的不同效果。方法 选择PCI发病时间12h内的急性ST段抬高型心肌梗死病人80例，随机分为溶栓组与急诊介入组（PCI组），每组40例，PCI组采用急诊介入治疗，溶栓组采用溶栓治疗。观察术前与术后即刻心电图ST段变化。观察治疗前与治疗后2h内的心电图ST段变化。结果 PCI组ST段回落≥50％为92．5％，溶栓组ST段回落≥50％为70．0％，PCI组疗效明显优于溶栓组（P〈0、05）。结论 在有条件的情况下，对急性ST段抬高型心肌梗死的病人可以首先考虑介入治疗。     

血栓抽吸联合替罗非班对急性ST段抬高心肌梗死患者心肌再灌注的影响

目的 探讨急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗（PCI）中联合应用ZEEK血栓抽吸导管和替罗非班对心肌组织灌注及临床预后的影响.方法 84例经冠脉造影证实为血栓负荷病变的急性ST段抬高心肌梗死患者随机分为血栓抽吸＋替罗非班42例（A组）和标准PCI 42例（B组）,比较两组患者手术后即刻梗死相关动脉（IRA）的心肌梗死溶栓（TIMI）血流、心肌灌注分级（MBG）、心电图ST段回落百分比、左心室射血分数（LVEF）及住院期间主要心脏不良事件（MACE）和出血性并发症发生率.结果 A组术后即刻TIMI血流、MBG、ST段抬高回落百分比及LVEF均明显优于B组（P〈0.05）,两组住院期间的MACE发生率及出血并发症比较差异无统计学意义（P〉0.05）.结论 在急性心肌梗死急诊PCI中联合使用ZEEK导管血栓抽吸和替罗非班安全可行,可有效清除冠状动脉内血栓,改善心肌组织灌注和术后心脏功能,并且不增加主要心脏不良事件的发生率.     

比伐芦定对行经皮冠状动脉介入治疗急性冠状动脉综合征患者冠状动脉微循环的影响及短期预后评价

目的 比较经皮冠状动脉介入治疗（PCI）中应用比伐芦定与普通肝素对急性冠状动脉综合征（ACS）患者冠状动脉微循环的影响及预后。方法 回顾性分析2020年1月至2023年3月在新疆医科大学附属中医医院急诊或住院接受PCI的312例ACS患者,分析一般临床资料,根据患者围术期的不同抗凝方案,分为比伐芦定组153例,普通肝素组159例,观察比较两组术后心肌梗死溶栓治疗试验（TIMI）血流分级、TIMI心肌灌注分级（TMPG）、心电图ST段回落率（STR）、心绞痛发作次数、术后7d内不良事件发生率、术后3个月内主要不良心血管事件（MACE）发生率和出血事件发生率。结果 两组患者的一般临床资料及介入术中情况比较,差异均无统计学意义（均P>0.05）。两组患者PCI术后TIMI血流分级差异无统计学意义（P=0.959）,但PCI术后TMPG、心绞痛发作次数、心电图STR比较,差异均有统计学意义（均P<0.05）。两组患者PCI术后7 d内不良事件发生率、PCI术后3个月内MACE的总发生率、PCI术后3个月内出血事件发生率比较,差异均无统计学意义（均P>0.05）。结论 比伐芦定...     

血栓抽吸导管在年轻急性ST段抬高型心肌梗死介入治疗中的应用研究

目的：探讨年轻急性ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）使用血栓抽吸导管的疗效及安全性。方法：79例年轻急性STEMI患者,根据急诊PCI是否使用血栓抽吸导管分为抽吸组（使用抽吸导管,37例）及常规治疗组（不使用抽吸导管,42例）,观察两组的术后冠脉血流 TIMI分级、心绞痛症状、心功能状况、主要不良心血管事件（MACE）等指标的差异。结果：与常规治疗组比较,抽吸组在术后 TIMI血流分级[（2.33±0.48）级比（3.00±0.00）级]、2h ST段50％回落率（45.24％比70.27％）、1周时的LVEF值[（47.21±9.28）％比（52.16±7.87）％]显著上升;心绞痛症状（50.00％比27.03％）、随访中心功能分级[（1.52±0.71）级比（1.22±0.42）级]显著减少或降低（P＜0.05或 P＜0.01）。MACE事件两组间比较差异无统计学意义（P均＞0.05）。结论：年轻急性ST段抬高型心肌梗死患者 PCI中使用血栓抽吸导管有助于改善冠脉血流,减少心绞痛症状,改善心功能,而且安全。     

急性心肌梗死患者经皮冠状动脉介入治疗术后ST段回落不良的分析

目的探讨ST段抬高急性心肌梗死(AMI)患者直接PCI术后ST段回落不良的相关因素。方法173例符合ST段抬高AMI诊断并行直接PCI的患者,计算其心电图ST段回落指数,运用logistic回归分析影响ST段回落的相关因素。结果冠状动脉造影心肌呈色分级0/1(OR=2.936)、病变部位(OR=2.121)、胸痛开始到再灌注的时间(OR=1.314)、梗死前心绞痛(OR=1.053)是影响术后心电图ST段恢复的相关因素。结论AMI直接PCI术后心电图ST段恢复程度与上述因素有关。     

老年急性ST段抬高心肌梗死急诊介入治疗后心肌组织水平再灌注不良的发生率及其对临床预后的影响

目的探讨老年急性心肌梗死（acute myocardial infarction,AMI）-急诊经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后心肌组织水平再灌注状态不良的发生率及其对近、远期临床预后的影响。方法回顾性收集398例老年急性ST段抬高心肌梗死（ST-elevationmyocardi-alinfarction,STEMI）行急诊PCI治疗患者的临床资料、冠状动脉造影资料与心电图,以ST段回落程度与TIMI心肌灌注（TIMIMyocardialPerfusion,TMP）分级等指标评估心肌组织水平再灌注状态,患者分为4组,A组为ST段回落率〉50%并且术后TMP分级为Ⅲ级;B组为ST段回落率〈50%而术后TMP分级=Ⅲ级;C组为术后TMP分级≤Ⅱ级而ST段回落率〉50%;D组为ST段回落率〈50%并且术后TMP分级≤Ⅱ级。分析心肌组织水平再灌注不良患者的发生率及其对近远期预后的影响。结果 STEMI急诊PCI术后梗死相关血管（infarctionrelatedartery,IRA）前向血流达到TIMIⅢ级而TMP分级为Ⅱ级以下者占37.2%,心电图ST段回落小于50%者占37.2%,均接近1/3。12.5%的患者具有远端栓塞。术后ST段回落率〉50%并且TMP分级为Ⅲ级者占总人数的39.8%,ST段回落率〈50%,并且术后TMP分级≤Ⅱ级占总人数的14.3%。心肌组织灌注状态不良者与心肌组织灌注状态良好者相比平均住院日更长,左室EF值更低,梗死后心绞痛发生率更高,远端栓塞发生率更高,IABP辅助应用比率更大,心功能恶化、心脏性死亡更高。与D组相比,随访期间MACE的发生风险在C组为43%（P=0.11）,在B组为24%（P〈0.01）,在A组为2.7%（P〈0.01）。结论老年急性心肌梗死行急诊PCI治疗后IRA再通者仅有不到40%的患者其心肌组织水平得到了良好的再灌注,其近、远期预后较好,而剩余约60%的患者其心肌组织水平存在不同程度的再灌注障碍,其中有大概约超过10%的患者其心肌组织水平存在较差的再灌注状态,这些患者在住院期间以及远期随访期间有着极高的MACE发生风险。     

作者单位：102600 北京市,首都医科大学大兴医院心内科通讯作者：郭丽敏,E-mail：chgj79@163.com

目的 评价急性心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)术后ST段回落幅度(STR)对近期预后的影响。方法 选择2012年1月至2015年6月在首都医科大学大兴医院住院的急性心肌梗死患者245例为研究对象,回顾性分析患者急诊PCI术后心电图单导联ST段回落幅度,将患者分为STR组和STR不良组,收集患者临床资料,比较两组患者住院期间心功能和主要不良心脏事件的差异。结果 STR组患者148例,STR不良组患者97例,STR不良发生率为39.6%。PCI术后TIMI血流达到3级而STR小于50%患者占32.5%。STR不良组患者住院期间B型利钠肽峰值为415.9±168.3pg/ml,左室舒张末期内径54.7±15.3mm,左室射血分数49.2±5.9%,与STR组比较差异有统计学意义(P＜0.05)。97例STR不良组患者中发生主要不良心脏事件(MACE)的患者共24例,其中恶性心律失常8例、心力衰竭11例和心源性死亡4例,其比例均高于STR组,差异有统计学意义(P＜0.05)。结论 急性心肌梗死患者急诊PCI术后仍有相当比例的患者发生ST段回落不良,这些患者具有较高的住院期间MACE发生率。     

临床路径对ST段抬高心肌梗死患者再灌注治疗疗效的影响

目的评价临床路径对急性ST段抬高心肌梗死患者就诊至球囊扩张时间、梗死心肌的再灌注治疗疗效的影响。方法随机选择100例实施急性ST段抬高心肌梗死急诊冠状动脉介入术临床路径的患者作为试验组,同时随机选择100例同期未实施临床路径的急性ST段抬高心肌梗死急诊冠状动脉介入术的住院患者为对照组。主要观察指标是就诊至球囊扩张时间、90 min目标时间内完成球囊扩张的比例、术中心肌梗死介入治疗后3级血流获得率及术后90 min ST段回落的比例、肌酸激酶同工酶酶峰值、住院病死率。结果试验组就诊至球囊扩张时间显著短于对照组(中位数,65 min比95 min,P<0.001),就诊90 min内完成球囊扩张的比例显著高于对照组(98%比65%,P<0.001)。临床路径显著提高术中心肌梗死介入治疗3级血流获得率(94%比81%,P<0.05)及术后90 min ST段回落>50%的比例(88%比67%,P<0.05),肌酸激酶同工酶酶峰值也明显提前(7.8±0.5比10.1±0.4,P<0.05),试验组住院病死率显著低于对照组(2%比7%,P<0.001)。结论临床路径可显著缩短就诊至球囊扩张时间,增加了90 min目标时间内完成球囊扩张的比例,能够更好地改善梗死区域心肌的微循环,显著提高梗死心肌的再灌注治疗疗效,这一作用对于降低住院病死率也具有非常显著的帮助,证实了临床路径管理是一种新的行之有效的服务管理模式。     

Primary versus rescue percutaneous coronary intervention in patients with acute myocardial infarction

OBJECTIVE: To compare angiographic and clinical outcomes of patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI) versus rescue PCI following failed thrombolysis. BACKGROUND: Patients presenting with AMI are treated either with primary PCI or with thrombolysis. When thrombolysis fails, rescue PCI is performed. METHODS AND RESULTS: We compared the outcome of 105 consecutive patients with AMI who underwent either primary PCI (60 patients) or rescue PCI (45 patients) between January 1997 and January 1999. The patients were followed for up to 6 months. Time delay to reperfusion was significantly longer in the rescue PCI group (354 vs. 189 min; p < 0.001). The majority of patients received a stent (93%). Glycoprotein (GP) IIb/IIIa inhibitors were used in 53% of patients in the primary PCI group and in 22% in the rescue group. TIMI grade 3 flow was achieved in 93.3% of patients in the primary PCI group and in 88.8% in the rescue group (p = 0.08). Post-procedure ejection fraction was 53% in the primary PCI group and 47% in the rescue group (p = 0.014). A composite endpoint of death, recurrent MI, repeat PCI, coronary artery bypass grafting (CABG) and recurrent angina at 6 months occurred in 35% of the patients in the primary PCI group and 26.7% in the rescue group (p = 0.36). CONCLUSION: Despite a significant delay to reperfusion and a lower immediate post-procedure ejection fraction, the clinical outcome of patients treated with rescue PCI following failed thrombolysis appears to be similar to that of patients treated with primary PCI at 6 months.     

血栓抽吸在老年急性ST段抬高型心肌梗死患者直接介入治疗中的应用

目的:探讨经皮冠状动脉内血栓抽吸术在血栓负荷重的急性ST段抬高型心肌梗死老年患者直接介入治疗(PCI)中的应用。方法:选择2009-01-2010-12期间在我院接受直接PCI的急性ST段抬高型心肌梗死老年患者117例,其中直接介入术加血栓抽吸治疗者为血栓抽吸组,共44例;仅行常规直接PCI者73例为对照组。研究初级终点为术后TIMI 3级血流率,次级终点为随访6个月的左心室射血分数(LVEF)、主要心血管病事件(MACE)发生率及纽约心功能分级。结果:血栓抽吸组术后TIMI 3级高于对照组,达到95.5%,术后肌酸激酶同工酶及TnI达峰时间稍提前于对照组,但与对照组比较均差异无统计学意义;随访6个月结果显示,累计MACE发生率在血栓抽吸组和对照组分别为4.6%和9.5%,差异无统计学意义,LVEF在住院1周时血栓抽吸组及对照组分别为[(51.4±9.2)%︰(48.0±11.8)%,P>0.05],随访6个月时分别为[(54.5±6.8)%︰(49.9±10.5)%,P<0.05];6个月时血栓抽吸组纽约心功能分级优于对照组,但差异无统计学意义。结论:血栓抽吸可以改善血栓负荷重的老年患者急诊PCI术后TIM...     

Effect of clopidogrel pretreatment on angiographic and clinical outcomes in patients undergoing primary percutaneous coronary intervention for ST-elevation acute myocardial infarction

Pretreatment with clopidogrel before elective primary percutaneous coronary intervention (PCI) has been shown to reduce ischemic complications. There are limited data about the value of clopidogrel pretreatment in the setting of PCI for ST-elevation myocardial infarction (STEMI). We aimed to examine the effect of clopidogrel preloading on angiographic and clinical outcomes in patients with STEMI who were treated with PCI. We conducted a prospective registry of all patients treated with primary PCI for STEMI from March 2003 to June 2006. Excluded were patients with cardiogenic shock. For the current analysis, patients (n = 292) were allocated into 2 groups. One group received clopidogrel loading dose before PCI (in the emergency department or coronary care unit, n = 165); the other,immediately after PCI (n = 127). TIMI myocardial perfusion (TMP) grade at the end of PCI and 30-day and 6-month clinical outcomes were assessed. Clinical characteristics were similar among the groups. However, patients pretreated with clopidogrel were more likely to receive aspirin and beta blockers before the current admission. TMP grade 3 occurred in a higher proportion of patients in the clopidogrel pretreatment group than in the no-pretreatment group (85% vs 71%, p = 0.01). Multivariate logistic regression analysis showed that clopidogrel pretreatment was associated with an odds ratio of 2.2 for TMP grade 3 (1.2 to 3.9, p = 0.01). Furthermore, the incidence of reinfarction at 30 days was lower in the pretreatment group (0% vs 3.2%, respectively, p = 0.04). In conclusion, these findings support the early use of clopidogrel in patients with STEMI who are treated with primary PCI.     

冠状动脉临界病变是否支架治疗的临床预后比较研究

目的观察和比较冠状动脉临界病变的非心肌梗死患者,采用介入、药物两种不同治疗方案的临床预后。方法选取2005年12月-2009午9月于我院住院的非心肌梗死冠心痛患者,经冠状动脉造影（CAG）证实为冠状动脉临界病变患者105例。根据患者意愿是否行冠状动脉内介入治疗将患者分为介入治疗组（PCI组）51例和单纯药物治疗组（MT组）54例,临床观察6～18个月内稳定心绞痛、不稳定心绞痛及心血管不良事件（心肌梗死,冠状动脉内血运重建,心源性死亡）发生情况。结果PCI组和MT组共发生心血管不良事件4例,PCI组发生1例为心脏性死亡,MT组发生3例为再次血运重建术。两组患者稳定型心绞痛的发生率分别为31．4％和37．0％,不稳定型心绞痛的发生率分别为19．6％和29．6％。以上比较差异均无统计学意义（P〉0．05）。结论冠状动脉临界病变患者行PCI与MT治疗相比发生心绞痛及心血管不良事件无显著差异。     

Prognostic Significance of T‐Wave Amplitude in Lead aVR on the Admission Electrocardiography in Patients with Anterior Wall ST‐Elevation Myocardial Infarction Treated by Primary Percutaneous Intervention

Background: T‐wave positivity in aVR lead patients with heart failure and anterior wall old ST‐segment elevation myocardial infarction (STEMI) are shown to have a higher frequency of cardiovascular mortality, although the effects on patients with STEMI treated with primary percutaneous coronary intervention (PCI) has not been investigated. In this study, we sought to determine the prognostic value of T wave in lead aVR on admission electrocardiography (ECG) for in‐hospital mortality in patients with anterior wall STEMI treated with primary PCI. Methods: After exclusion, 169 consecutive patients with anterior wall STEMI (mean age: 55 ± 12.9 years; 145 men) undergoing primary PCI were prospectively enrolled in this study. Patients were classified as a T‐wave positive (n = 53, group 1) or T‐wave negative (n = 116, group 2) in aVR based upon the admission ECG. All patients were evaluated with respect to clinical features, primary PCI findings, and in‐hospital clinical results. Results: T‐wave positive patients who received primary PCI were older, multivessel disease was significantly more frequent and the duration of the patient's hospital stay was longer than T‐wave negative patients. In‐hospital mortality tended to be higher in the group 1 when compared with group 2 (7.5% vs 1.7% respectively, P = 0.05). After adjusting the baseline characteristics, positive T wave remained an independent predictor of in hospital mortality (odds ratio: 4.41; 95% confidence interval 1.2–22.1, P = 0.05). Conclusions: T‐wave positivity in lead aVR among patients with an anterior wall STEMI treated with primary PCI is associated with an increase in hospital cardiovascular mortality.     

盐酸替罗非班对急性心肌梗死急诊经皮冠状动脉介入治疗中TIMI血流影响的临床研究

目的分析Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班对ST段抬高急性心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)治疗中TIMI血流的影响。方法选择急诊入院STEMI患者48名,分为试验组(盐酸替罗非班+PCI)27例和对照组(直接PCI)21例。收集所有病例的临床和冠状动脉造影资料,观察PCI术前、术后TIMI血流情况。结果试验组于术前应用盐酸替罗非班使PCI前梗死相关血管TIMI血流分级提高,试验组达1级血流者比例高于对照组(37%比9.5%,P<0.05);对照组完全闭塞者比例明显高于试验组(38.1%比7.4%,P<0.01);两组患者PCI术后TIMI3级血流比例差异无统计学意义,TIMI2级血流比例试验组低于对照组。结论Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班可改善STEMI患者梗死相关血管的TIMI血流。     

Age-related differences in treatment strategies and clinical outcomes in unselected cohort of patients with ST-segment elevation myocardial infarction transferred for primary angioplasty

Data concerning the benefits and risks of primary PCI in the elderly patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Thus, the objective of the study was to assess age-dependent differences in the treatment and outcomes of STEMI patients transferred for primary PCI. Data were gathered on 1,650 consecutive STEMI patients from hospital networks in seven countries of Europe from November 2005 to January 2007 (the EUROTRANSFER Registry population). Patients <65, 65 to 74, 75 to 84, and ≥ 85 years of age comprised 49.3, 27.5, 20.2, and 3 % of the registry population, respectively. Elderly patients were higher risk individuals and have experienced longer delays to reperfusion than their younger counterparts and were more likely to be treated conservatively after coronary angiography. Despite similar frequency of TIMI 3 flow before PCI, elderly patients were less likely to achieve TIMI 3 flow and ST-segment resolution >50 % after PCI, and were more likely to have PCI complications. The rates of death at 30 days, as well as at 1 year were increased with age. In the Cox regression analysis model age was an independent predictor of 30-day mortality. A trend toward higher risk of major bleeding requiring transfusion was observed. Age was an important determinant of treatment strategies selection and clinical outcomes in the group of consecutive STEMI patients transferred for primary PCI. Further efforts should be made to reduce delays and to optimize treatment of STEMI, regardless of patients' age.     

Racial disparity in clinical outcomes following primary percutaneous coronary intervention for ST elevation myocardial infarction: influence of process of care

Previous studies have shown that compared with white patients, non-white patients with ST elevation myocardial infarction (STEMI) have worse clinical outcomes. Differences in co-morbidities, extent and severity of coronary artery disease, health insurance, and socioeconomic status have been identified as possible reasons for this disparity. However, an alternative explanation for such observed disparities in outcomes could be differences in process of care. For example, in most of these studies, non-white patients were less likely to receive reperfusion therapy, and if treated, were more likely to receive thrombolysis than to undergo primary percutaneous coronary intervention (PCI). We hypothesized that if all patients were treated similarly with primary PCI, there would be no difference in clinical outcomes. We analyzed the demographic, angiographic, in-hospital clinical outcomes, and long-term mortality rates of a racially diverse group of patients presenting to the same hospital with STEMI, all of whom were treated with primary PCI. Our data demonstrate that compared with white patients, non-white patients with STEMI who undergo primary PCI have similar in-hospital clinical outcomes and one-year mortality. This suggests that the previously observed differences in mortality rates may be, at least in part, attributable to differences in the process of care, and not solely to differences in patient factors or differential therapeutic effects.     

Impact of thrombus aspiration use and direct stenting on final myocardial blush score in patients presenting with ST-elevation myocardial infarction

BackgroundMany studies have reported that low final thrombolysis in myocardial infarction (TIMI) flow and/or myocardial blush grade (MBG) are independent predictors of mortality in patients with ST-elevation myocardial infarction (STEMI). In addition, distal coronary embolization is a major pitfall of conventional percutaneous coronary intervention (PCI) in such a context.AimThis study aimed to assess the impact of thrombus aspiration (TA) use before primary PCI on final myocardial reperfusion in patients presenting with STEMI.MethodsFrom January to December 2006, 100 patients presenting with STEMI in our catheterization laboratory were considered for the present study. During this time period, 50 patients underwent TA before primary PCI for treatment of STEMI and were then matched 1:1 to 50 controls who underwent conventional primary PCI for treatment of STEMI without TA. Patients of the control group were chosen after matching on age±3 years, sex, history of diabetes, and distribution of the infarct related coronary artery during the same period.ResultsBaseline clinical characteristics, initial TIMI flow and initial MBG of both groups were similar. There was a trend for a better final TIMI flow in the group with TA and the final MBG was significantly improved in the group with TA compared to the group without TA: final MBG of two or three in 70% versus 30% of the cases (P=.001). In addition, direct stenting was significantly more often used in the TA group (92% versus 64%, P=.001). There were four patients with evident distal embolizations in the group without TA and none in the group with TA.ConclusionTA use before primary PCI for STEMI treatment resulted in improved final myocardial reperfusion. Of importance, TA use may have led to a better choice of the stent size and more frequent direct stenting. This benefit may directly improve patient outcomes.