联合血栓抽吸在ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗中应用的效果  

Effect of thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

作　　者：沈冲 王乐丰[2] Shen Chong;Wang Lefeng(Graduate School of Capital Medical University,Beijing 100069,China;Department of Cardiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学研究生院,100069 [2]首都医科大学附属朝阳医院心内科,100020

出　　处：《中华心血管病杂志》2019年第1期49-55,共7页Chinese Journal of Cardiology

摘　　要：目的探讨联合血栓抽吸在ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PPCI)中应用的效果。方法采用回顾性研究方法,纳入2013年1月至2014年3月在首都医科大学附属北京朝阳医院行PPCI的STEMI患者321例。根据介入治疗是否联合血栓抽吸,将入选患者分为PPCI组(189例)和联合血栓抽吸组(132例)。收集患者基本资料、PPCI术中和围手术期资料,记录术后主要终点事件(包括全因死亡、再次心肌梗死和冠状动脉血运重建)和次要终点事件(包括心原性死亡、再发心绞痛、靶病变血运重建和支架内血栓形成)的发生情况。结果PPCI组与联合血栓抽吸组的年龄[(59.8±12.5)岁比(58.3±14.4)岁,P=0.060]和男性比例[82.5%(156/189)比82.6%(109/132),P=0.993]差异均无统计学意义。联合血栓抽吸组患者的病变血管数多于PPCI组[(1.59±0.81)支比(1.47±0.70)支,P=0.039],梗死相关动脉为左前降支的比例高于PPCI组[52.3%(69/132)比38.6%(73/189),P=0.022],症状发作时间[3.0(2.0,4.8)h比4.0(2.0,7.0)h,P=0.027]和心肌缺血时间[3.9(2.7,6.2)h比4.7(2.9,7.9)h,P=0.022]均短于PPCI组,血栓心肌梗死溶栓试验(TIMI)分级≥4级[92.4%(122/132)比75.1%(142/189),P<0.001]和术后血流TIMI分级为3级[70.5%(93/132)比60.8%(115/189),P=0.003]的比例均高于PPCI组。PPCI组随访时间为(31.6±7.5)个月,联合血栓抽吸组随访时间为(32.2±6.7)个月(P=0.466)。PPCI组与联合血栓抽吸组术后主要终点事件发生率差异无统计学意义[17.1%(22/129)比16.9%(31/184),P=0.962]。联合血栓抽吸组术后再发心绞痛发生率高于PPCI组[25.6%(33/129)比16.3%(30/184),P=0.044];联合血栓抽吸组与PPCI组术后心原性死亡[3.1%(4/129)比3.3%(6/184),P=1.000]、靶病变血运重建[3.9%(5/129)比3.3%(6/184),P=0.765]和支架血栓形成[3.1%(4/129)比2.7%(5/184),P=1.000]差异均无统计学意义。多因素Cox回归分析显示,冠状动脉病变血管数(RR=1.901,95%CI1.217~2.970,P=0.005)和术后血�Objective To investigate the effect of thrombus aspiration during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods This retrospective study included 321 STEMI patients who underwent PPCI at Beijing Chaoyang hospital from January 2013 to March 2014. Patients were divided into the PPCI group (189 cases) and the PPCI plus thrombus aspiration group (132 cases). Baseline and perioperative clinical data, procedural characteristics were collected, and primary endpoint events including all-cause death, re-myocardial infarction, and coronary revascularization and secondary endpoint events including cardiac death, recurrent angina, target lesion revascularization, and stent thrombosis were recorded during the follow-up. Results There were no significant difference between PPCI group and PPCI plus aspiration group in age ((59.8±12.5) years old vs. (58.3±14.4) years old, P=0.060) and male ratio (82.5% (156/189) vs. 82.6% (109/132), P=0.993). The number of disease vessels (1.59±0.81 vs. 1.47±0.70, P=0.039) and the prevalence of left anterior descending as infarction related artery (52.3% (69/132) vs. 38.6% (73/189), P=0.022) were significantly higher in the PPCI plus aspiration group than that in the PPCI group.The symptom onset time (3.0 (2.0,4.8) hours vs. 4.0 (2.0,7.0) hours, P=0.027) and myocardial ischemia time (3.9 (2.7,6.2) hours vs. 4.7 (2.9,7.9) hours, P=0.022) were significantly in the PPCI plus aspiration group than in the PPCI group. The percent of thrombolysis in myocardial infarction (TIMI) thrombosis score≥ grade 4 (92.4% (122/132) vs. 75.1% (142/189), P<0.001)and postoperative TIMI flow grade 3 (70.5% (93/132) vs. 60.8% (115/189), P=0.003) was significantly higher in the PPCI plus aspiration group than in the PPCI group. The PPCI group patients were followed up for (31.6±7.5) months, and PPCI plus aspiration group patients were followed up for (32.2±6.7) months (P=0.466). During the follow-up period, there was no significant

关 键 词：心肌梗死 经皮冠状动脉介入治疗 血栓抽吸 

分 类 号：R542.22[医药卫生—心血管疾病]