急性ST段抬高型心肌梗死患者行经皮冠状动脉介入治疗联合血栓抽吸术的疗效观察

Clinical effect of thrombus aspiration combined with primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

关键词:  急性ST段抬高型心肌梗死  急诊介入治疗  血栓抽吸

Key words:  acute ST-segment elevation myocardial infarction  emergency percutaneous coronary intervention  thrombus aspiration

摘要:

目的　评价急性ST段抬高型心肌梗死患者行急诊介入治疗联合血栓抽吸对患者的预后疗效。 方法　回顾性分析2014 年1 月至2015 年1 月共313 例急性ST段抬高型心肌梗死行急诊介入治疗患者的临床资料，分为联合血栓抽吸组（n=97)和直接PCI组(n=216)。应用SPSS统计软件进行t检验、非参数检验，对两组患者在基本资料（年龄、性别）、冠脉危险因素（吸烟、糖尿病、高血压）、入院时基本临床资料［血钾、血糖(GLU）、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)、血肌酐(Cr)、缺血时间和KILLIP分级］、造影结果（罪犯血管、非罪犯血管数、后扩张数、TIMI分级、）、术后LVEF以及MACE(主要不良心血管事件)进行比较。 结果　两组患者在基本资料、冠脉危险因素、入院时基本临床资料、冠脉造影结果以及术后LVEF方面，差异均无显著性意义(P>0.05)，而在Cr及罪犯血管方面差异有显著性意义（P<0.05）。平均随访12 个月，MACE率联合抽吸组 25.8% ，直接PCI组16.2%，两组比较，差异有显著性意义（P=0.047) 。结论　急性ST段抬高型心肌梗死患者行急诊介入治疗中，联合血栓抽吸治疗并不能够降低远期MACE事件。

Abstract:

Objective　To assess impact of thrombus aspiration combined with percutaneous coronary intervention (PCI) on long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Methods　Between Jan. 2014 and Jan. 2015, a total of 313 STEMI patients were enrolled and divided into thrombus aspiration combined with PCI group (n=97) and PCI group (n=216) according to whether thrombus aspiration was performed before intervention. The two groups were compared based on the following aspects: age, sex, main risk factors, clinical features, pathological changes of coronary artery lesions and LEVF (left ventricular ejection fraction) after PCI. The incidence of major adverse cardiac event (MACE) was comparatively analyzed in the two groups during 12-month follow-up. And T-test, non-parametric test and Logisic regression analysis were conducted by using SPSS software. Results　The two groups were similar for age, sex, main risk factors, clinical features, pathological changes of coronary artery lesions and LEVF after PCI. At 12-month follow-up, MACE was 25.8% in thrombus aspiration combined with PCI group and 16.2% in PCI group, respectively (P=0.047). Conclusion　In patients with STEMI, thrombus aspiration combined with PCI cannot reduce the incidence of long-term MACE.