血栓抽吸对急性心肌梗死患者心室重构及预后的影响

目的探讨急性心肌梗死（AMI）患者直接经皮冠状动脉内介入治疗（PCI）中，应用血栓抽吸导管进行血栓抽吸对心室重构及临床预后的影响。方法选择2010年1月至2011年9月在我院心内科住院并诊断为急性sT段抬高心肌梗死（srEMI）患者270例，随机（抛硬币法）分为对照组（常规PCI组）140例及血栓抽吸组130例。检测患者直接PCI后心肌灌注指标包括术后2hST段回落（STR）和TIMI心肌灌注分级（TMPG）。所有患者均于术后5-7d及出院6个月后行超声心动图测定左室舒张末期内径（LVEDd）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVEsv）及左室射血分数（LVEF），比较两组患者术后心肌灌注及心室重构指标的差异。对患者随访12个月，动态追踪观察两组患者随访期内心血管不良事件（MACE）的发生情况。结果血栓抽吸组STEMI患者直接PCI术后STR比例及TMPG良好比例均显著高于对照组（64．6％比45．0％，70．0％比48．6％，P〈0．01）。出院6个月后，血栓抽吸组患者LVEDd、LVEDV、LVESV显著小于对照组，而LVEF则高于对照组（54．53±2．73）比（56．79±2．46，（118．74±4．34）比（121．23±3．52），（58．44±3．79）比（61．94±3．83），（49．62±3．32）比（48．12±2．15），P〈0．05]。术后随访12个月，Kaplan—Meier生存分析发现，血栓抽吸组患者累积无MACE事件生存率显著高于对照组，差异有统计学意义（92．3％比82．3％，Logrank=4．187，P=0．041）。结论对STEMI患者急诊介入治疗中先应用血栓抽吸导管进行血栓抽吸再行PCI，可以显著改善患者心肌灌注水平，减轻术后左心室重构，并改善患者的临床预后。

Influences of thrombus aspiration on ventricular remodeling and clinical prognosis of patients with acute myocardial infarction

Objective To investigate the influence of thrombus aspiration on ventricular remodeling ofpatients with acute myocardial infarction who underwent primary percutaneous coronary intervention （PCI） and its predicative value for patients prognosis. Methods 270 ST-segment elevation myocardial infarction （STEMI） pa- tients who hospitalized in our department of cardiology from January 2010 to September 2011 were enrolled and randomly divided into two groups： control group including 140 cases and thrombus aspiration group including 130 cases. Indexes of myocardial perfusion levels such as ST-Segment resolution （STR） 2 hours after PCI and TIMI myocardial perfusion grade （TMPG） were measured in all patients. All patients accepted echocardiography exami- nations 5-7 days after PCI and 6 months after discharge. Patients were followed up for 12 months and Major car- diac adverse events （MACE） in follow-up period were recorded. Results Compared with control group, patients in thrombus aspiration group had better myocardial perfusion level, less left ventricular remodeling and higher left ventricular ejection fraction （P〈0.05 or P〈0.01 ）. After 12 months of follow-up, Kaplan-Meier survival analysis showed patients of the two groups had significantly different cumulative non-events survival rates（92.3% vs 82.3%, Log rank=4.187, P=0.041 ）. Multivariate logistic regression analysis indicated that thrombus aspiration was an inde- pendent predictorof better clinical prognosis in STEMI patients. Conclusion Thrombus aspiration can improve the myocardial perfusion level in patients with STEMI who underwent primary PCI and reduce left ventricular remodel- ing. It also can improve the prognosis of STEMI patients.