急诊经皮冠状动脉介入治疗中联合应用抽吸导管有效性的随访研究

目的 评价ST段抬高心肌梗死(STEMI)行急诊PCI术中联合应用抽吸导管的有效性.方法 回顾性评价首诊符合STEMI并经绿色通道行急诊经皮冠状动脉介入治疗(PCI),并经冠状动脉造影(CAG)明确梗死相关冠状动脉(IRA)完全闭塞的96例患者的临床资料.根据是否联合应用抽吸导管,将96例患者分为抽吸导管组(n=48)和非抽吸导管组(n=48).结果 两组患者除性别外(10.4%比29.2%,P=0.021),一般临床特征无统计学差异.两组IRA除右冠状动脉病变分别为64.6%、39.6%,P=0.014,其余差异无统计学意义.两组PCI即时TIMI血流分别为2.8±0.6、3.0±0.2,P<0.001;两组术后90 min ST回落>70%分别为72.9%、52.1%,P=0.035;植入支架类型及个数两组间无差异;未见术中出血并发症.术后1个月及1年随访,两组的左室舒张末容积(LVEDV)及左室射血分数(LVEF)无统计学差异;平均1年随访期间,两组主要不良心血管事件(MACE)无统计学差异,但抽吸导管组有降低趋势(logRank χ2=0.266,P=0.013).平均1年随访期间发生MACE组(n=43)和非MACE组(n=53)"无复流"分别为9.3%、0,P=0.023;术中IABP支持分别为21.4%、1.9%,P=0.002;发病-球囊扩张时间分别为(3.6±2.0、2.1±1.0)h,P=0.002;Killip分级分别为1.8±1.1、1.2±0.7,P<0.001;PCI即时TIMI分别为2.9±0.3、2.6±0.7,P<0.001.结论 急诊PCI中联合应用抽吸导管能改善心肌灌注,术后发生MACE可能与"无复流"、术中IABP支持、发病-球囊扩张时间、Killip分级、PCI即时TIMI等因素有关.

Follow-up study of the effectiveness of primary percutaneous coronary interventional procedure combined with thrombus aspiration

Objective: To evaluate the effectiveness of ST-segment elevation myocardial infarction(STEMI) undergoing primary PCI combined with thrombus aspiration.Methods: In this single-center retrospective evaluation,96 patients with the firstly diagnosed STEMI,with coronary angiography(CAG) showing infarct-related coronary artery(IRA) occlusion and undergoing primary percutaneous coronary intervention(PCI) were divided into two groups: thrombus aspiration group(n=48),non-thrombus aspiration group(n=48).Results: In addition to sex(10.4% vs 29.2%,P=0.021),general clinical features of two groups of patients had no statistical difference.In addition to the right coronary artery disease with the infarct-related coronary artery(IRA) occlusion being 64.6% vs 39.6%(P=0.014),the rest had no difference between two groups;PCI instant TIMI flow grade(2.8 ± 0.6 vs 3.0 ± 0.2,P<0.001) and the complete ST segment resolution rate(72.9% vs 52.1%,P=0.035) between two groups were significantly different;type and number of stents implanted had no difference between the two groups;no bleeding complications occurred in two groups.After 1 month and 1 year follow-up,left ventricular end-diastolic volume(LVEDV) and left ventricular ejection fraction(LVEF) had no significant difference between two groups;during average 1-year follow-up period,two major adverse cardiac events(MACE) had no significant difference,but there was a tendency to decrease in MACE rate at 1-year follow-up,which favored thrombus aspiration catheter group(log rank χ2=0.266,P=0.013).Average 1-year follow-up between MACE group(n=43) and non-MACE group(n=53) showed significant differences: no-reflow(9.3% vs 0%,P=0.023),IABP support(21.4% vs 1.9%,P=0.002),disease-balloon time[(3.6±2.0) h vs(2.1±1.0) h,P=0.002],Killip classification(1.8±1.1 vs 1.2±0.7,P<0.001),PCI instant TIMI flow grade 3(2.9±0.3 vs 2.6±0.7,P<0.001).Conclusion: Primary PCI in combined with thrombus aspiration catheter can improve myocardial perfusion,MACE occurred after primary PCI may be related to no-flow,IABP support,the incidence-balloon time,Killip classification,PCI instant TIMI.