急性心肌梗死直接PCI先行血栓抽吸对预后的影响

Thrombus aspiration before angiography during percutaneous coronary intervention in acute myocardial infarction

关键词:  血栓抽吸  急性心肌梗死  预后

Key words:  thrombus aspiration  ST elevation myocardial infarction  prognosis

摘要:

［目的］探讨急性ST段抬高型心肌梗死（STEMI）血栓病变的直接经皮冠状动脉介入治疗（primary pecutaneous coronary intervention，PPCI）中，先行血栓抽吸与常规PCI两种治疗策略对患者预后的影响。［方法］2007年2月～2009年8月连续入院、诊断为急性STEMI并接受直接PCI的患者共164例，随机分为先抽吸组（D组）与常规PCI组（P组）两组。比较两组治疗前后血栓积分、TIMI计帧分级、无复流现象的改善以及术后1周的射血分数，术后随访1年时无严重心脏不良事件（MACE）的累计生存率。［结果］抽吸前后D组较P组血栓负荷明显降低（P=0.011）。D组无复流现象的发生明显低于P组（9.6 %对26.4%，P=0.008），TIMI计帧血流（帧）明显改善［（23.15±7.57）对（27.03±7.81），P=0.002］。支架植入后D组获得更大的管腔直径（mm） ［（3.24±0.36）对（3.11±0.30），P=0.01］与更短的支架长度（mm）［（24.26±11.45）对（29.19±13.69），P=0.002］。术后1周射血分数（%）D组高于P组［（51.73±7.55）对（47.75±8.18），P=0.002 ］。术后随访1年，D组再发心绞痛者明显低于P组，但两组再发心梗及死亡率差异无显著性意义。D组无MACE存活率明显高于P组（90.4% 对 75.8%，P=0.016）。［结论］急性ST抬高型心肌梗死血栓病变的直接PCI中，首先进行血栓抽吸与常规PCI相比，不仅能有效降低血栓负荷，增加心肌的有效灌注，而且改善患者预后，在血栓负荷较重的患者中应作为首选治疗措施。

Abstract:

［Objective］To compare the efficacy and prognosis of treatment between thrombus aspiration and conventional procedures during primary percutaneous coronary intervention (PPCI) in ST elevation myocardial infarction (STEMI) patients with coronary thrombus.［Methods］From February 2007 to August 2009,total 164 consecutive patients during PPCI were randomized to take initial treatment with thrombus aspiration first (D group) and conventional PCI (P group).［Results］None of them had device-related complications.Compared to P group,D group achieved better results in TIMI thrombus grade (P=0.011),TIMI Frame Count (P=0.002) without reflow phenomenon (9.6 % vs 26.4%,P=0.008),and more lumen diameter [(3.24±0.365) mm vs (3.11±0.30) mm,P=0.01],less stent length [(24.26 ±11.45)mm vs (29.19 ±13.69)mm,P=0.002].Ejection fraction (EF%) of D group was improved [（51.73±7.55) vs (47.75±8.18), P=0.002] in 1 week.Cumulative Survival with MACE free in D group was significant higher than that in P group (90.4% vs 75.8%,P=0.016) in 1 year follow-up.［Conclusions］Compared with conventional PCI,initial treatment thrombus aspiration first in patients with STEMI and coronary thrombus is safe and effective and improves prognosis in the patients.