摘要
目的评价经皮冠状动脉介入治疗(PCI)联合血栓抽吸术与单纯PCI对ST段抬高型心肌梗死(STEMI)患者预后的影响。方法选取2012年3月—2014年5月在同济大学附属第十人民医院心内科住院治疗的STEMI患者358例,随机分入血栓抽吸组和对照组,每组179例。血栓抽吸组患者于冠状动脉造影后先行血栓抽吸再行PCI,对照组患者于冠状动脉造影后直接行PCI。收集并比较两组患者术后冠状动脉血流分级\[心肌梗死溶栓治疗临床试验(TIMI)分级\],PCI术后6、12、18、24h监测的肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白T(cTnT)峰值、PCI术前和术后60min心电图ST段抬高回落百分比(sumSTR)。患者出院后通过电话或门诊随访,记录术后1年有无主要不良心血管事件(MACE)发生。结果两组间术前各级TIMI血流、术中见心肌梗死相关动脉,以及病变血管构成比的差异均无统计学意义(P值均>0.05)。血栓抽吸组术后TIMI 3级、sumSTR>70%的构成比均显著高于对照组(P值均<0.01),sumSTR<30%的构成比,血浆CK-MB和cTnT峰值均显著低于对照组(P值均<0.05、0.01)。术后1年随访中,两组间未用药,以及服用阿司匹林、氯吡格雷、他汀类药物、β肾上腺素受体阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、硝酸酯类药物和利尿剂的患者构成比的差异均无统计学意义(P值均>0.05)。两组间术后1年心源性死亡、再发心肌梗死、心源性休克和纽约心脏病学会心功能分级Ⅳ级发生率的差异均无统计学意义(P值均>0.05)。结论血栓抽吸联合PCI可有效减少STEMI患者术后无复流和慢血流的发生,改善心肌再灌注,并有助于缩小心肌梗死面积。
Objective To compare the clinical outcomes between percutaneous coronary intervention （PCI） and PCI combined with thrombus aspiration in treatment of patients with ST-segment elevation myocardial infarction （STEMI）. Methods A total of 358 hospitalized patients with STEMI treated in the Shanghai Tenth People＇s Hospital were equally divided into either thrombus aspiration group or conventional treatment group （n = 179） before coronary angiography. Thrombolysis in myocardial infarction （TIMI） flow, peak values of creatine kinase isoenzyme-MB （CK-MB） and cardiac troponin T （cTnT）, and summed ST-segment resolution （sumSTR）across all infarct-related electrocardiogram （ECG） leads were recorded before and after treatment. Major adverse cardiac events （MACE）, such as cardiac death, recurrent myocardial infarction, cardiogenic shock and heart failure, were recorded during one-year follow-up. Results There were no significant differences in preoperative TIMI flow, infarct-related artery or coronary lesions between the two groups （all P〉0. 05）. The thrombus aspiration group had a higher rate of postoperative TIMI 3 flow and sumSTR〉70% and lower peak values of CK- MB and cTnT when compared with conventional treatment group （P〈0.01 or P〈0.05）. However, no significant difference was detected between the two groups in prescribed medication or the incidence of MACE during one- year follow-up （all P〉0.05）. Conclusion Compared with conventional PCI, thrombus aspiration before stent implantation in the infarct artery can significantly improve the myocardial perfusion, decrease the incidence of no- reflow and slow flow and infarct size in STEMI patients.
出处
《上海医学》
CAS
CSCD
北大核心
2015年第3期179-184,共6页
Shanghai Medical Journal
基金
加拿大CANNeCTIN/CIHR基金会资助项目(TOTAL#118-SITE#801)~~
关键词
ST段抬高型心肌梗死
经皮冠状动脉介入治疗
血栓形成
血栓抽吸
Export抽吸导管
ST-segment elevation myocardial infarction
Percutaneous coronary intervention
Coronarythrombosis
Thrombus aspiration
Export thrombotic aspiration catheter
