直接置入国产药物洗脱支架对急性心肌梗死心肌无复流现象的影响

目的评价无球囊预扩张直接置入国产药物洗脱支架对急性心肌梗死（AMI）血管再通后心肌无复流（NR）现象的影响。方法将100例ST段抬高型AMI患者随机分为无球囊预扩张直接置入国产药物洗脱支架组（直接支架组）和球囊预扩张后置入冠状动脉内支架组（预扩张组）,应用心肌梗死溶栓治疗试验（TIMI）血流分级、校正的TIMI计帧法（CTFC）、心肌呈色分级（MBG）、心电图ST段回落（≥50%）和肌酸激酶同工酶（CK-MB）峰值和峰值时间来评价两种方法对AMI患者NR的影响。结果两组虽然术后即刻TIMI血流分级差异无统计学意义,但直接支架组与预扩张组比较,术后即刻CTFC显著减少[（23.10±4.51）帧vs.（25.53±5.09）帧,P〈0.05）]、MBG 2～3级显著增高（90%vs.74%,P〈0.05）、NR发生率显著减少（10%vs.26%,P〈0.05）;术后60 min心电图ST段回落≥50%发生率显著增加（88%vs.70%,P〈0.05）,直接支架组CK-MB峰值显著减少[（217.2±96.86）U/Lvs.（260.22±97.78）U/L,P〈0.05]、CK-MB峰值时间显著提前[（11.72±2.67）hvs.（13.7±2.06）h,P〈0.05]。结论无球囊预扩张直接置入国产药物洗脱支架可降低AMI血管再通后心肌NR的发生,缩小梗死面积。

Domestic rapamycin-eluting stents implantation without predilation on myocardium no-reflow in patients with acute myocardial infarction

Objective To investigate whether direct domestic rapamycin-eluting stents implanting might prevent the myocardium no-reflow in patients with ST-segment elevated acute myocardial infarction（STEMI） compared with stenting after balloon predilation.Methods A total of 100 STEMI patients undergoing percutaneous coronary intervention（PCI） were randomly enrolled into direct stenting group（n=50） and stenting after balloon predilation group（n=50）.The effects were evaluated by thrombolysis in myocardial infarction（TIMI）,corrected TIMI frame count（CTFC）,myocardial blush grading（MBG）,ST-segment resolution（STR）,the levels and time of peak creatine kinase-myocardial band（CK-MB）,the clinical outcome and coronary angiography after 6 months.Results Immediate TIMI was similar in direct stenting and stenting after balloon predilation（94% vs.90%,P〉0.05）.However,immediate CTFC decreased and MBG 2～3 increased significantly after PCI（23.10±4.51 vs.25.53±5.09,P〈0.05;90% vs.74%,respectively,P〈0.05）,the rate of no-reflow（NR） decreased significantly（10% vs.26%,P〈0.05） and STR≥50% 60 min after PCI increased significantly（88% vs.70%,PV〈0.05）.The peak CK-MB levels and the peak CK-MB time were significantly different in direct stenting and stenting after balloon predilation [（217.2±96.86）U/L,（11.72±2.67）h vs.（260.22±97.78）U/L,（13.7±2.06）h,respectively,P〈0.05].Conclusions Direct domestic rapamycin-eluting stenting without predilation may decrease NR,reduce the infraction area in patients with AMI compared with stenting after balloon predilation.