准分子激光冠脉消融术在急性ST段抬高型心肌梗死直接经皮冠脉介入治疗中的应用

目的评价准分子激光冠脉消融术(ELCA)在富含血栓的急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)中应用的有效性和安全性。方法 2016年11月至2018年2月锦州医科大学北部战区总医院连续纳入25例富含血栓的STEMI患者,分成单纯球囊扩张成形术和(或)支架术(对照组n=13)和辅助的ELCA治疗组(ELCA组n=12),采用冠脉造影或冠状动脉定量测量(QCA)评估TIMI血流、TIMI血栓分级、校正的TIMI帧数(CTFC)、最小血管腔直径(MLD)和直径狭窄程度(DS),主要观察终点为手术即刻成功率和临床成功率。结果与对照组相比,ELCA组左心室射血分数更低(49.0±11)%比(61.2±7.9)%,P=0.006],其他一般资料包括生活习性、既往史和冠脉造影指标,差异均无统计学意义(P>0.05)。PCI相关指标中,除球囊预扩张指标(P=0.022)外,其余差异均无统计学意义(P>0.05)。ELCA组手术即刻成功率为100%,术中未观察到无复流、夹层、冠脉穿孔等并发症,对照组发生慢血流2例,无复流1例,手术即刻成功率76.9%。采用CTFC评价系统评估术前和术后即刻冠脉灌注血流情况,ELCA组由(67.81±16.5)帧减少至(34.63±14.7)帧,对照组(55.77±12.10)帧减少至(39.54±12.54)帧,二者差异有统计学意义(P<0.05),两组MLD和DS差异无统计学意义(P>0.05)。住院期间及6个月随访期间,ELCA组无MACE事件发生,对照组发生MACE事件2例(因心衰再次住院)。结论 ELCA应用于富含血栓的STEMI直接PCI可提高心外膜血流,改善心肌灌注,减少慢血流或无复流风险,具有较高的即刻成功率和临床成功率,可作为急性心肌梗死直接PCI的辅助治疗手段。

Application of excimer laser coronary atherectomy in STEMI during primary percutaneous coronary intervention

Objective To evaluate the effectiveness and safety of excimer laser coronary atherectomy(ELCA)in ST-segment elevation myocardial infarction(STEMI)during percutaneous coronary intervention(PCI).Methods Twenty-five patients with STEMI were enrolled and randomized to balloon angioplasty and/or stenting(control group, n=13)and adjunctive ELCAtreated study group(ELCA group, n=12).Coronary angiography or Quantitative Coronary Angiography(QCA)was used to assess TIMI(thrombolysis in myocardial infarction)flow,TIMI thrombosis staging,corrected TIMI frames(CTFC),minimum lumen diameter(MLD)and diameter stenosis(DS).The primary endpoint was the immediate procedure success rate and the clinical success rate.Results Compared with the control group, the ELCA group had a lower left ventricular ejection fraction(LVEF)(49.0±11)% vs(61.2±7.9)%,P=0.006].There was no significant difference between the two groups in living habits,past history,or coronary angiography results(P>0.05).Among PCI related indicators, except balloon pre-expansion(P=0.022),the rest had no significant difference(P>0.05).Immediate success rate of ELCA groups was 100%,and the occurrence of no-reflow,distal embolization or perforation was not identified during the operation.In the control group,there were two case of slow blood flow and one case of no-reflow.Immediate success rate of control groups was 76.9%.CTFC evaluation system was used to evaluate the blood flow of coronary artery before and immediately after PCI. In ELCA group it decreased from(67.81±16.5)to(34.63±14.7)and in the control group from(55.77±12.10)to(39.54±12.54).There was significant difference between the two groups(P<0.05).However,there was no significant difference in MLD or DS between two groups(P> 0.05).Follow-up data of 180 days showed ELCA-treated study group had no MACE events.Two MACE events occurred in the control group(hospitalized again for heart failure).Conclusion The application of ELCA can improve epicardial blood flow,promote myocardial perfusion and have a high immediate procedure success rate and clinical success rate in patients with STEMI undergoing primary PCI and has low occurrence of slow/no-reflow, which can be used as assistant treatment methods in primary PCI for acute myocardial infarction.