Diver CE血栓抽吸导管与替罗非班对老年急性心肌梗死患者心肌再灌注的作用和安全性比较

目的比较在老年患者急诊经皮冠状动脉介入(PCI)术中,Diver CE血栓抽吸导管与替罗非班对心肌再灌注水平的作用、安全性和对患者预后的影响。方法 76例接受急诊PCI术的老年ST段抬高型急性心肌梗死患者,造影证实病变处有明显血栓负荷,将患者随机分组,抽吸组39例患者应用Diver CE血栓抽吸导管抽吸血栓后行PCI治疗,替罗非班组37例患者造影后给予替罗非班+PCI治疗。比较两组心肌灌注水平、并发症发生率和随访6个月心血管事件发生率。结果抽吸组和替罗非班组术后无复流现象发生率、罪犯血管TIMI血流帧数(TFC)、心肌呈色分级、2h内ST段回落率分别是2.6%vs.16.2%、48.1±10.3vs.63.2±14.3、2.59±0.48vs.1.68±0.43,84.6%(33例)vs.62.2%(23例),抽吸组心肌灌注水平明显优于替罗非班组(均P<0.05)。替罗非班组出血并发症发生率明显高于抽吸组。随访6个月,两组心血管事件(心绞痛、心肌梗死、心力衰竭、心因性死亡)发生率分别为14.7%和38.2%,差异有统计学意义(P<0.05)。结论在接受急诊PCI术的老年患者中,对血栓负荷重的病变应用Diver CE血栓抽吸导管,与替罗非班相比更安全,并能明显改善患者的心肌再灌注和预后。

Comparison of effect and safety of Diver CE aspiration catheter and tirofiban on myocardial reperfusion in elderly patients with acute myocardial infarction

Objective To compare the effect and safety of Diver CE aspiration catheter to that of tirofiban on myocardial reperfusion and prognosis in elderly patients with ST-segment elevation myocardial infarction（STEMI）.Methods 76 STEMI elderly patients with high thrombus burden in culprit vascular undergoing primary percutaneous coronary intervention（PCI）were divided randomly into two groups-aspiration group and tirofiban group.All patients in two groups were treated by primary PCI,patients in tirofiban group were given tirofiban intravenous and Diver CE catheter was used to aspirate the thrombus in 39 patients of therapy group.Between two groups,the basline characteristics,angiographic results were compared.Results In aspiration group and tirofiban group,the rate of slow-reflow phenomenon,TIMI frame count（TFC）,myocardial blush grade（MBG）,ST-segment resolution within two hours after operation was respectively 2.6% vs.16.2%,48.1±10.3 vs.63.2±14.3,2.59±0.48 vs.1.68±0.43,84.6% vs.62.2%.Patients in the aspiration group achieved better myocardial reperfusion.During 6-month follow-up 14.7% patients in aspiration group and 38.2% in tirofiban group developed major adverse cardiac events（MACE,including angina pectory,myocardia infarction,heart failure and death of heart disease）,there is significant statistical difference between two groups（P0.05）.Conclusions In elderly STEMI patients with high thrombus burden,application of Diver CE aspiration thrombectomy catheter during primary PCI,compared with tirofiban,is safer and can greatly improve myocardial reperfusion and reduce incidence of MACE during six-month follow-up.