急性心肌梗死心源性休克冠脉血栓抽吸并支架置入术的疗效及其安全性

 目的 评价冠脉血栓抽吸并支架置入术治疗急性心肌梗死心源性休克的疗效与安全性。方法 选择39例急性心肌梗死并冠脉血栓形成的心源性休克患者为血栓抽吸组,并选择经冠脉造影明确诊断为急性心肌梗死且无冠脉血栓者32例作为对照组,比较两组使用主动脉内球囊反搏术(IABP)、临时起搏器,术前冠脉血流分级、冠状动脉病变支数、冠状动脉病变部位、置入支架、再通冠脉血流分级、主要心脏不良事件等。结果 血栓抽吸组使用IABP(79.5% vs 25.0%)、临时起搏器(76.9% vs 28.1%)比例均高于对照组,差异有统计学意义(P<0.05)。术前冠脉血流分级、冠状动脉病变支数、冠状动脉病变部位、置入支架、再通冠脉血流分级、术中主要心脏不良事件等比较,两组无统计学差异。随访一年,两组主要心脏不良事件和心功能等指标比较均无统计学差异。 结论 急诊冠脉血栓抽吸并支架置入术救治急性心肌梗死并心源性休克患者是安全有效的,不增加心血管不良事件。

Efficacy and safty of aspiration thrombectomy catheter and stent implantation for patients with acute myocardial infarction complicated by cardiogenic shock

Objective To evaluate the therapeutic effect and safty of aspiration thrombectomy catheter and stent implantation for patients with acute myocardial infarction complicated by cardiogenic shock. Methods The coronary thrombus aspiration group which consisted of 39 patients with acute myocardial infarction(AMI) complicated by cardiogenic shock(CS) of 39 infarction related coronary artery (IRA) in 46 target lesion underwent emergency aspiration thrombectomy catheter and stent implantation. Results The control group consisting of 32 cases of postoperative coronary blood flow by thrombolysis in myocardial infarction(TIMI) included grade Ⅲ in 30 cases (93.8%), grade Ⅱ (TIMI) in 1 case (3.1%) and grade Ⅰ in 1 case (3.1%). The success rates of IRA and interventional treatment of target lesion were 93.8% and 84.4%, respectively(successful treatment to restore blood flow TIMI Ⅲ). During 12 months of follow-up,in the 29 patients from the control group,there were digestive tract hemorrhage in 2 cases (6.3%), heart failure in 4 cases (12.5%), death in 1 case (3.1%), acute myocardial infarction again in 3 cases (9.4%).In the 39 cases from the coronary thrombus aspiration group, the success rates of aspiration thrombectomy, IRA and interventional treatment of target lesion were 92.1%,92.3%(P=0.81)and 84.6%,respectively(P=0.16). Conclusions The application of emergency coronary aspiration thrombectomy catheter and stent implantation in patients with acute myocardial infarction and cardiac shock is safe and effective.