急性ST段抬高型心肌梗死患者急诊介入治疗即刻与延迟支架置入对冠状动脉血流的影响  

Effect of immediate and delayed stent implantation on coronary blood flow in patients with acute ST-segment elevation myocardial infarction

作　　者：王晨阳 董豪坚 罗德谋[1] 周颖玲[1] WANG Chen-yang;DONG Hao-jian;LUO De-mou;ZHOU Ying-ling(Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所、广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2021年第3期254-258,共5页South China Journal of Cardiovascular Diseases

基　　金：国家重点研究开发计划项目(项目编号:2016YFC1301202)。

摘　　要：目的观察在高血栓负荷的急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者中不同支架置入策略对“罪犯血管”血流状态和短期预后的影响,为进一步优化针对高血栓负荷的急性心肌梗死患者的再灌注治疗策略提供依据。方法选择2019年1月至2020年1月在广东省人民医院及广东省人民医院珠海分院就诊的需行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的STEMI患者,开通梗死相关血管后,恢复心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)3级血流的患者245例,分为两组。一组采用传统的即刻支架置入术(n=194);另外一组采用延期支架置入策略(n=51),给予积极的药物治疗3~5 d后,再次复查造影,评估靶血管病变的情况,进行延期支架置入。对比评价即刻置入支架术和延期3~5 d置入支架两种策略出现慢血流或无复流的发生率。通过对比两组冠状动脉靶血管支架置入后TIMI血流分级、TIMI心肌灌注分级(TIMI myocardial perfusion grading,TMPG)以及术后心电图和心肌标志物等参数,评价两种支架置入策略的优劣,探讨延迟支架置入策略是否可以减少无复流或者慢血流的发生率,为进一步临床研究和更好地改善急性心肌梗死的介入策略提供依据。结果即刻支架组与延迟支架组患者的术中慢血流或无复流占比分别为17.0%与10.2%,差异无统计学意义(P=0.21)。延迟支架组患者术后TIMI 3级血流占90.2%,优于即刻支架组的83.0%,差异无统计学意义(P=0.48)。延迟支架组与即刻支架组患者术后TMPG 2~3级分别占100%与53.1%,延迟支架组患者的TMPG血流较即刻支架组有改善,差异有统计学意义(P<0.01)。两组患者住院期间主要不良心血管事件(major adverse cardiovascular event,MACE)发生率比较,差异无统计学意义(P>0.05)。结论与标准即刻支架置入相比,STEMI患者延迟支架置入不能降低住院期间�Objectives To observe the effects of different stent placement strategies on the blood flow status and short term prognosis of“culprit vessels”in patients with acute ST-segment elevation myocardial infarction(STEMI)with high thrombus load,so as to provide basis for further optimizing the reperfusion treatment strategy in patients with STEMI with high thrombus load.Methods From January 2019 to January 2020,245 patients with STEMI who need emergency percutaneous coronary intervention(PCI)in Guangdong Provincial People′s Hospital and Zhuhai branch of Guangdong Provincial People′s Hospital were selected and divided into two groups.One group(n=194)was treated with traditional immediate stent implantation.The other group(n=51)was treated with delayed stent placement strategy.After active drug treatment for 3-5 days,the angiography was reexamined again to evaluate the target vessel lesions and carry out delayed stent placement.The incidence of slow blood flow or no blood reflow between immediate stenting and 3-5 day delayed stenting were compared and evaluated.The advantages and disadvantages of the two stenting strategies were evaluated and compared by thrombolysis in myocardial infarction(TIMI)flow classification,TIMI myocardial perfusion grading(TMPG),postoperative electrocardiogram(ECG)and cardiac markers between the two groups,so as to evaluate and explore whether the delayed stenting strategy can reduce the incidence of no blood reflow or slow blood flow and to provide reference for further clinical research and better intervention strategy of acute myocardial infarction.Results The proportion of slow blood flow and no blood reflow in immediate stent group and delayed stent group were 17.0%and 10.2%respectively,and the difference was not statistically significant(P=0.21).The TIMI grade 3 blood flow of delayed stent group was 90.2%,which was better than that of immediate stent group(83.0%)(P=0.48).TMPG grade 2-3 was 100%in delayed stent group and 53.1%in immediate stent group.The blood flow of TMPG in delay

关 键 词：心肌梗死 延迟支架 无复流 慢血流 

分 类 号：R542.22[医药卫生—心血管疾病]