延迟支架置入术在高血栓负荷急性ST段抬高型心肌梗死患者急诊冠状动脉介入治疗中的应用

目的观察高血栓负荷急性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)后靶病变的变化及延迟支架置入情况。方法入选48例高血栓负荷STEMI患者,急诊予单纯球囊扩张和(或)冠状动脉血栓抽吸,梗死相关动脉前向血流心肌梗死溶栓试验(TIMI)血流分级3级,7 d后复查冠状动脉造影(CAG),根据靶病变血管狭窄情况必要时置入支架治疗。观察靶病变变化的相关数据,包括狭窄程度、长度、近端参考血管直径、远端参考血管直径,比较老年患者(≥60岁)和中青年患者(<60岁)支架置入比例。结果 7 d后复查CAG显示靶病变直径狭窄程度较直接PCI时减轻(35.5%±14.1%比48.8%±11.0%,P<0.01)、病变长度缩短(15.69±5.36)mm比(18.94±5.37)mm,P<0.01],靶病变近端参考血管直径(3.29±0.33)mm比(3.24±0.32)mm,P=0.02]和远端参考血管直径(3.18±0.33)mm比(3.08±0.33)mm,P<0.01]增大;其中,39.6%(19/48)患者因靶病变狭窄>50%置入支架,老年患者和中青年患者置入支架比例分别是56%(9/16)、31%(10/32)(P=0.04)。结论对于中青年高血栓负荷不适宜直接支架置入术的STEMI患者急诊予单纯球囊扩张和(或)血栓抽吸即时开通梗死相关动脉,再延迟必要时支架置入治疗策略是安全、有效的。

Delayed stent implantation in acute ST-segment elevation myocardial infarction patients with high thrombus burden in primary percutaneous coronary intervention

Objective To evaluate the changes of target lesions and delayed stent implantation after primary percutaneous coronary intervention （PCI） in high thrombus tmrden patients with acute ST elevation myocardial infarction （STEMI）. Methods A total of 48 STEM1 patients with high thrombus burden underwent primary PCI were enrolled. After treatment of percutaneous transtuminal coronary angioplasty （PTCA） only and/or catheter aspiration of coronary thrombus, the forward blood flow in infarct-related arteries got thrombolysis in myocardial infarction （TIMI） flow grade 3. All patients accepted coronary angiography （CAG） 7 days after primary PCI and the stenosis of target lesion and delayed stent implantation were evaluated. Data of target lesion changes including degree, length of stenosis, diameter of proximal and distal reference vessel were collected. Stenting proportions were compared between elderly patients （ ≥60 ys） and young and middle-aged patients （ 〈 60 ys）. Results Compared with the data of primary PCI, the stenosis degree alleviated （35.5%± 14. 1% vs. 48.8% ± 11.1%, P 〈 0. 01 ）, the length of stenosis shortened （ 18.94 ±5.37）ram vs. （ 15.69 ±5.36）mm, P 〈0. 01 ], both diameters of proximal （3.24± 0. 32）mm vs. （3.29 ±0. 33） mm,P =0. 02] and distal （3.08 ±0. 33）ram vs. （3.18 ±0. 33）mm, P 〈 0.01 ] reference vessel increased when CAG preformed 7 days later. 39. 6% （19/48）of the patients received delayed stenting for stenosis 〉50% in target lesion. 56% （9/16） of the elderly and 31% （10/32） of the young and middle-aged patients （ P = 0. 04） accepted delayed stent implantation. Conclusions For young and middle-aged STEMI patients with high thrombus burden and unsuitable for primary stenting, the strategy of reperfusing infarct-related artery with primary PTCA and/or catheter aspiration of coronary thrombus, and delayed stenting when necessary is safe and effective.