经桡动脉应用单根JL3.5指引导管完成心电图指导下罪犯血管急诊介入治疗对心肌梗死门囊时间的影响  

Effect on door-to-balloon time of ECG-guided immediate intervention for culprit vessle using a transradial single JL3.5 guiding catheter——a randomized study

作　　者：王国忠[1] 华琦[2] 柳子静[1] 李紫旋 吴永霞 李怀东[1] 张利彬[1] 徐荣[1] 郭金成[1] WANG Guo-zhong;HUA Qi;LIU Zi-jing;LI Zi-xuan;WU Yong-xia;LI Huai-dong;ZHANG Li-bin;XU Rong;GUO Jin-cheng(Department of Cardiology,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China;Department of Cardiology,Beijing Xuanwu Hospital,Capital Medical University,Beijing 10054,China)

机构地区：[1]首都医科大学附属北京潞河医院心内科,北京市101149 [2]首都医科大学附属北京宣武医院心内科

出　　处：《中国心血管病研究》2021年第11期1011-1017,共7页Chinese Journal of Cardiovascular Research

基　　金：首都卫生发展科研专项项目(2018-2-7082)。

摘　　要：目的探讨心电图指导下经桡动脉采用单根JL3.5指引导管对急性ST段抬高性心肌梗死(STEMI)患者梗死相关动脉(IRA)急诊经皮冠状动脉介入治疗(PCI)对门囊(D2B)时间的影响。方法选取2017年8月至2019年5月我中心连续收治拟行急诊PCI的252例STEMI患者随机分为两组:单导管组(n=126)应用JL3.5指引导管首先完成心电图识别的IRA造影和介入治疗,然后完成对侧冠状动脉造影。对照组(n=126)采用多功能造影导管完成双侧冠状动脉造影,然后行IRA介入治疗。研究主要终点是D2B时间,次要终点包括导管室门囊(C2B)时间和30天主要不良心脑血管事件(MACCE),包括死亡、再发心肌梗死、靶血管重建、卒中,30天出血学术研究联合会(BARC)出血分级≥3级出血事件,采用意向性分析两组结果。结果与对照组相比,单导管组D2B中位数时间[52.83(41.18~67.20)min比58.16(47.30~81.07)min,P=0.013]、C2B中位数时间[17.00(14.53~21.85)min比25.68(21.10~32.00)min,P<0.001]和透视时间[8.56(6.03~12.20)min比10.16(7.36~13.50)min,P=0.007]均显著减少。单导管组D2B≤90 min和≤60 min达标率明显高于对照组(90.48%比80.95%,P=0.031;61.11%比45.24%,P=0.012)。两组更换至股动脉比例(3.17%比3.97%,P=1.000)、造影成功率(96.03%比94.44%,P=0.554)、导管更换率(6.35%比11.11%,P=0.181)和操作成功率(91.27%比85.71%,P=0.167)相似,两组均无导管操作相关并发症发生。30天MACCE(3.97%比6.35%,P=0.393)和BARC≥3级出血事件(0.79%比1.59%,P>0.05)两组无差异。结论心电图指导下经桡动脉应用单根JL3.5指引导管直接行STEMI患者IRA急诊PCI治疗可以明显缩短D2B时间、C2B时间和透视时间,提高D2B时间达标率。Objective To investigate the impact of using a single transradial guiding catheter for ECGguided immediate infarct-related artery(IRA) percutaneous coronary intervention(PCI) on door to balloon(D2 B)time. Methods From August 2017 to May 2019, 252 patients presented with ST segment elevation myocardial infarction(STEMI) at our institution were randomized(1:1) into two groups. In single catheter group(n=126), a single guiding catheter(6 F JL3.5) was used for ECG-guided immediate IRA PCI followed by contralateral angiography. In control group(n=126), complete coronary angiography was performed by 5 F Tiger II diagnostic catheter, followed by guiding catheter selection for IRA PCI. The primary endpoint was D2 B time and second endpoint included catheterization laboratory door to balloon(C2 B) time,major adverse cardiovascular and cerebrovascular events(MACCE) including death, reinfarction, target vessel revascularization and stroke at 30 days and BARC≥3 type bleeding events. Results The baseline characteristics were not different between the two groups. The median D2 B time [52.83(41.18~67.20) min vs. 58.16(47.30~81.07) min, P=0.013], C2 B time [17.00(14.53~21.85) min vs. 25.68(21.10~32.00) min,P<0.001] and fluoroscopy time [8.56(6.03~12.20) min vs. 10.16(7.36~13.50) min, P=0.007] were significantly shorter in single catheter group compared with control group. The proportion of patients achieving D2 B time within 90 minutes and 60 minutes increased significantly in the single catheter group(90.48% vs. 80.95%, P=0.031;61.11% vs. 45.24%, P=0.012). The rate of crossover to femoral artery(3.17% vs. 3.97%, P=1.000), angiography success(96.03% vs. 94.44%, P=0.554), catheter exchange(6.35%vs. 11.11%, P=0.181) and procedure success(91.27% vs. 85.71%, P=0.167) were similar in the two groups. There was no complication related to catheter operation in both groups. There was no signi fi cant difference in the MACCE at 30 days(3.97% vs. 6.35%, P=0.393)and BARC≥3 bleeding events(0.79% vs. 1.59%,P>0.05)between 2 groups. Conclus

关 键 词：心肌梗死 门囊时间 血管成形术 经桡动脉介入 罪犯血管 

分 类 号：R542.22[医药卫生—心血管疾病]