急诊经皮冠状动脉介入中血栓抽吸对ST段抬高性心肌梗死患者预后的影响

目的 评价在急性ST段抬高性心肌梗死（STEMI）急诊经皮冠状动脉介入（PCI）中应用血栓抽吸导管进行血栓抽吸患者的临床预后.方法 选择2007年10月1日至2008年11月30日在我中心接受急诊介入治疗的STEMI患者共83例,其中急诊介入术加血栓抽吸治疗者为血栓抽吸组共40例,同期条件相当仅行急诊介入治疗患者作为常规PCI组共43例,研究初级终点为术后即刻心肌灌注、术后2 h ST段回落率;次级终点为30 d、6个月和1年的左心室射血分数（LVEF）改善情况和主要心血管病事件（MACE）发生率.结果 冠状动脉心肌灌注分级（TMP）2～3级获得率在血栓抽吸组为90.0%（36例）,常规PCI组为69.8%（30例）,2组比较差异有统计学意义（x^2=5.2,P＜0.05）.校正的TIMI记帧法（CTFC）值（30.3±8.1）比43.1±7.6）,t=7.43,P＜0.01]及术后2 h心电图ST段回落大于50%率（37例,92.5%比28例,65.1%,x2=9.15,P＜0.01）,血栓抽吸组均明显优于常规PCI组,差异有统计学意义.随访1年结果显示,2组累计MACE发生率在血栓抽吸组为2.5%,常规PCI组为9.3%;LVEF在随访30 d、6个月和1年时分别为（56.3±2.9）%比（53.7±3.1）%,（58.1±2.5）%比（54.6±2.9）%,（62.4±2.7）%比（58.7±3.2）%],血栓抽吸组随访结果均优于常规PCI组,但差异无统计学意义.结论 血栓抽吸在STEMI急诊PCI中安全可行,可以明显改善心肌灌注水平并促进ST段回落,减少随访1年时的临床MACE发生率.

The effect of thrombus-aspiration during emergency percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

Objective To evaluate the effect of thrombus-aspiration during emergency percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction(STEMI). Methods The STEMI patients underwent emergent PCI from 1 October 2007 to 30 November 2008. 40 patients received PCI and aspiration thrombectomy were enrolled in study group and 43 patients who only received routine PCI were enrolled in control group. TIMI myocardial perfusion(TMP) , CTFC, ST-segment declining in 2 h, left ventricular ejection fraction ( LVEF) and major adverse cardiac event(MACE)after operation and the follow-up data were compared between the tow groups. Results TMP 2-3 was achieved in 90.0% of patients in thrombus aspiration group and in 69. 8% in the control group(P <0.05). The thrombus aspiration group had more CTFC (30. 3±8. 1) vs(43.1±7.6),t=7.43, P<0.01]and faster ST segment declining in 2 h(92.5% vs 65. 1% ), x2 =9. 15, P <0.01] than the control groups. The total MACE were 2. 5% in the study group and 9. 3% in the control group after 1 year(P >0. 05). Compared with control group, LVEF of the study groups were improved (56. 3 ±2. 9% vs 53. 7±3. 1% ,58.1 ±2. 5% vs 54. 6 ± 2. 9% , 62. 4±2. 7% vs 58. 7 ± 3. 2% ) ] in the follow-up (P > 0. 05 ). Conclusions Thrombus-aspiration is safe and effective, which can improve myocardial reperfusion and ST-segment declining in 2 h, abate MACE in STEMI.