急性ST段抬高心肌梗死冠状动脉内血栓抽吸后延迟支架植入术的疗效观察

目的对急性ST段抬高性心肌梗死患者行急诊冠状动脉介入（percutaneous coronary intervention，PCI）治疗，经冠状动脉内血栓抽吸后使心肌梗死溶栓试验（TIMI）血流达3级后，比较延期支架植入与即刻支架植入两种治疗方式对预后的影响。方法选择2010年1月至2012年1月符合急诊PCI治疗条件的急性心肌梗患者共149例．经冠状动脉内血栓抽吸后使心肌梗死溶栓试验血流达2～3级后，93例当时植入支架患者为即刻支架植入组．56例术后经强化抗凝及抗血小板治疗5～7d后再次手术植入支架者为延迟支架植入组，观察两组ST段术后回落超过50％的患者例数、慢血流或无复流发生率、心肌染色分级及支架使用情况，同时随访术后3个月时心功能状态及主要心血管事件（包括心肌梗死、血运重建、卒中、各种原因的死亡）。结果延期支架组心电图ST段回落比例明显高于即刻支架植入组，差异有统计学意义（62％vs.46％，P〈0．01）。无复流及慢血流在延迟支架组明显少于即刻支架组，差异有统计学意义（8％vs．17％，P〈0．01）。延迟支架组支架使用量明显少于即刻支架组，差异有统计学了意义（2．3±0．7）枚 vs.（3．5±1．1）枚，P〈0．01]。3个月后两组主要心血管事件及左心室功能状态比较，差异无统计学意义（P〉0．05）。结论冠状动脉内血栓抽吸后延迟支架植入，可减少支架使用量，有利于减少无复流及慢血流现象的发生，对近期预后无不利影响。

Clinical observation of delayed stenting undergoing catheter therapy of thrombus aspiration in patients with ST-segment elevation acute myocardial infarction

Objectives To compare different impacts of delayed stent implantation and instant stent implantation on the prognosis in patients with ST-segment elevation acute myocardial infarction （STEMI） with thrombolysis in myocardial infarction （TIMI） flow grades 2-3 undergoing primary emergency percutaneous coronary intervention （PCI） with catheter therapy of thrombus aspiration. Methods Totally 149 cases complied with emergency PCI with TIM1 flow grades 2-3 undergoing catheter therapy of thrombus aspiration were enrolled from January 2010 to January 2012. Of them, 93 cases with instant stent implantation were in immediate stenting group, 56 cases with stent implantation after postoperative enhanced anticoagulation and antiplatelet therapy for 5-7 days were in delayed stenting group. Cases of ST-fall index more than 50%, incidence of coronary slow flow or no reflow, myocardial blush grade, stent usage of the two groups were compared. Cardiac function and major adverse cardiovascular events （including myocardial infarction, revascularization, stoke, death of all causes） 3 months after stent implantation were followed up. Results Cases of ST-fall index more than 5% was significantly higher in delayed stenting group than in immediate stenting group （62% vs. 46%, P〈0.01 ）. Incidence of coronary slow flow or no reflow was significantly less in delayed stenting group than in immediate stenting group （8% vs. 17%, P〈0.01 ）. Amount of stents was significantly less in delayed stenting group than in immediate stenting group （2.3±0.7 vs. 3.5±1.1, P〈0.01 ）. Major adverse cardiovascular events and left ventricular function had no significant difference after 3 months＇ follow-up between the two groups （P〉0.05）. Conclusions Delayed stenting undergoing catheter therapy of thrombus aspiration can reduce the amount of stent usage, reduce no reflow and slow flow, and has no adverse effect on short-term prognosis.