老年急性ST段抬高型心肌梗死高血栓负荷病人经血栓抽吸和重组人尿激酶原治疗后择期PCI对心肌微灌注的影响和预后研究  

Myocardial microperfusion and prognosis in elderly patients with high thrombus burden of acute ST segment elevation myocardial infarction undergoing selective PCI after thrombus aspiration and recombinant human prourokinase

作　　者：罗德锋[1] 栾波[1] 侯爱洁[1] 王成福[1] 赵宏伟[1] 孟庆坤[1] 张晓娇 李毅[1] 王永 LUO De-feng;LUAN Bo;HOU Ai-jie;WANG Cheng-fu;ZHAO Hong-wei;MENG Qing-kun;ZHANG Xiao-jiao;LI Yi;WANG Yong(Cardiovascular Disease Treatment Center,the People’s Hospital of Liaoning Province,Shenyang 110000,China)

机构地区：[1]辽宁省人民医院心血管病治疗中心,辽宁省沈阳市110000

出　　处：《实用老年医学》2022年第9期888-891,896,共5页Practical Geriatrics

基　　金：辽宁省社发重大专项(2020JH1/10300002)。

摘　　要：目的探讨老年急性ST段抬高型心肌梗死(STEMI)高血栓负荷(HTB)病人经血栓抽吸和靶向冠脉内给予重组人尿激酶原(rhPro-UK)后择期行经皮冠状动脉介入治疗(PCI)对心肌微灌注和预后的影响。方法连续入选141例老年STEMI-HTB病人分为急诊PCI组(69例)和延迟PCI组(72例)。延迟PCI组经血栓抽吸后靶向冠脉内给予rhPro-UK,待恢复心肌梗死溶栓治疗(TIMI)2~3级血流后,择期行PCI治疗;急诊PCI组经血栓抽吸后急诊行PCI治疗。比较2组病人基线资料、介入相关指标、心肌微灌注水平与预后情况。结果延迟PCI组病人肌酸激酶同工酶(CK-MB)峰值和肌钙蛋白I(cTnI)峰值显著低于急诊PCI组(P<0.05)。延迟PCI组病人支架植入数目、支架长度、慢血流/无复流比例、校正的TIMI帧数(cTFC)和TIMI心肌灌注帧数(TMPFC)显著低于急诊PCI组病人(P<0.05)。随访1个月,2组全因死亡、脑卒中、靶血管再次血运重建(TVR)和心力衰竭发生率差异均无统计学意义(P>0.05)。延迟PCI组病人随访1个月后LVEF显著高于急诊PCI组病人(P=0.038)。住院期间和随访1个月,2组病人大出血和小出血事件发生率差异均无统计学意义(P>0.05)。结论延迟PCI可显著改善老年STEMI-HTB病人心肌微灌注水平,改善病人心功能,且不增加出血事件的风险。Objective To investigate the effect of selective percutaneous coronary intervention(PCI)on myocardial microperfusion and prognosis in the elderly patients with acute ST segment elevation myocardial infarction(STEMI)and high thrombus burden(HTB)after thrombus aspiration and targeted intracoronary administration of recombinant human prourokinase(rhPro-UK).Methods A total of 141 elderly patients with STEMI-HTB were consecutively divided into emergency PCI group(69 cases)and delayed PCI group(72 cases).The delayed PCI group underwent selective PCI after receiving rhPro-UK to restore thrombolysis in myocardial infarction(TIMI)2-3 degree blood flow by puncturing balloon after thrombus aspiration;The emergency PCI group underwent emergency PCI after thrombus aspiration.The baseline information,intervention related indicators,myocardial microperfusion and prognosis of the two groups were compared.Results The peak value of creatine kinase myocardial isoenzyme(CK-MB),cardiac troponin I(cTnI),the number of stents implanted,the length of stents,the ratio of slow flow/no reflow,the corrected TIMI frames(cTFC)and TIMI myocardial perfusion frame count(TMPFC)in delayed PCI group were significantly lower than those in emergency PCI group(P<0.05).At 1 month follow-up,there were no significant differences in all-cause death,stroke,target vessel revascularization(TVR)and heart failure between the emergency PCI group and the delayed PCI group(P>0.05).The level of left ventricular ejection fraction(LVEF)in the delayed PCI group one month later was significantly higher than that in the emergency PCI group(P=0.038).There were no significant differences in major and minor bleeding events between the two groups in hospital and during one month of follow-up(P>0.05).Conclusions Delayed PCI can significantly improve the myocardial microperfusion and cardiac function in the elderly patients with STEMI-HTB without an increase in major and minor bleeding.

关 键 词：急性ST段抬高型心肌梗死 延迟PCI 微血管 

分 类 号：R542.22[医药卫生—心血管疾病]