血栓抽吸联合冠状动脉内溶栓对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术后冠状动脉微循环的影响  

Impact of Thrombus Aspiration Combined With Intracoronary Thrombolysis on Coronary Microcirculation Post Primary Percutaneous Coronary Intervention in Patients With ST-elevation Myocardial Infarction and High Thrombus Load

作　　者：刘金武 荣晶晶 刘征宇[1] 何晋[1] 张宇[1] 王长录[1] 邹琼超[1] 彭翔[1] 王鹏[1] 张乐[1] 向媛媛 郑鹏飞 贺彩红 杨秋霞 龙宇博 傅庆华[1] 郑昭芬[1] 潘宏伟[1] LIU Jinwu;RONG Jingjing;LIU Zhengyu;HE Jin;ZHANG Yu;WANG Changlu;ZOU Qiongchao;PENG Xiang;WANG Peng;ZHANG Le;XIANG Yuanyuan;ZHENG Pengfei;HE Caihong;YANG Qiuxia;LONG Yubo;FU Qinghua;ZHENG Zhaofen;PAN Hongwei(Department of Cardiology,Clinical Research Center for Heart Failure in Hunan Province,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha(410005),Hunan,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)湖南省心力衰竭临床医学研究中心心血管内科,长沙市410005 [2]湖南省娄底市中心医院心血管内

出　　处：《中国循环杂志》2022年第11期1097-1104,共8页Chinese Circulation Journal

基　　金：湖南省社会发展领域重点研发项目(2019SK2021);湖南省发改委项目(2019FGW27)。

摘　　要：目的:评价血栓抽吸联合冠状动脉内溶栓对急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术后冠状动脉微循环障碍的临床效果。方法:连续纳入湖南省人民医院2017年1月至2021年12月期间入院的STEMI患者1 351例。根据所采用的罪犯血管高血栓负荷不同处理方式,将患者分为冠状动脉内单纯血栓抽吸组(单纯抽吸组,n=938)和血栓抽吸联合冠状动脉内溶栓组(联合治疗组,n=413),又将联合治疗组分为先溶栓再抽吸亚组(n=102)和先抽吸再溶栓亚组(n=311)。使用1:2倾向性匹配法调整患者基线。利用基于定量血流分数的微循环阻力指数(AMR)、校正TIMI帧计数(CTFC)、术后1小时心电图ST段回落幅度等评价指标,比较单纯抽吸组和联合治疗组的冠状动脉微循环改善情况,以及先溶栓再抽吸亚组和先抽吸再溶栓亚组的冠状动脉微循环改善情况。结果:匹配后,联合治疗组413例,单纯抽吸组826例,两组一般基线资料差异均无统计学意义(P均> 0.05);联合治疗组AMR、CTFC均低于单纯抽吸组;术后1小时心电图ST段回落幅度,TIMI心肌灌注分级(TMPG)3级、心肌灌注显影分级(MBG)3级、术后TIMI血流3级的患者占比均高于单纯抽吸组(P均<0.001)。匹配后,先溶栓再抽吸亚组102例,先抽吸再溶栓亚组204例,两亚组一般基线资料差异均无统计学意义(P均> 0.05);先抽吸再溶栓亚组AMR、CTFC均低于先溶栓再抽吸亚组,术后TIMI血流3级患者占比高于先溶栓再抽吸亚组(P均<0.001);此外,两亚组的TMPG、MBG、术后1小时心电图ST段回落幅度差异均无统计学意义(P均> 0.05)。结论:与单纯血栓抽吸比,血栓抽吸联合冠状动脉内溶栓可更好地改善高血栓负荷的STEMI患者PCI术后冠状动脉微循环障碍。先血栓抽吸再溶栓对微循环的改善效果更佳。Objectives: To analyze the clinical effect of thrombus aspiration combined with intracoronary thrombolysis on coronary microcirculation post primary percutaneous coronary intervention(PCI) in patients with acute ST-elevation myocardial infarction(STEMI) and high thrombus load.Methods: This study included 1 351 patients with STEMI and high thrombus load, who were hospitalized in Hunan Provincial People’s Hospital from January 2017 to December 2021. The clinical data were collected and analyzed. Based on the various treatment options applied for inferring culprit vessels with high thrombus load, the patients were divided into intracoronary thrombus aspiration-only group(aspiration-only group, n=938) and thrombus aspiration combined with intracoronary thrombolysis group(combined treatment group, n=413). Patients in the combined treatment group were further divided into pre-aspiration thrombolysis subgroup(n=102) and post-aspiration thrombolysis subgroup(n=311). A 1:2 propensity matching method was used to balance the baseline characteristics of the patients. The angio-based microvascular resistance(AMR), corrected TIMI frame count(CTFC), ST-resolution at one hour post PCI were used to determine the status of coronary microcirculation.Results: There were 413 cases in the combined treatment group, while 826 cases were in the solely aspiration group after matching. There was no significant difference in general baseline information between the two groups(all P>0.05).AMR and CTFC values were significantly lower in the combined treatment group than in aspiration-only group(both P<0.001). The ST-segment resolution at one hour post operation was significantly higher in the combined treatment group than in the aspiration-only group(P<0.001). Proportion of patients with post-operative TIMI myocardial perfusion grade(TMPG) 3, post-operative myocardial blush grade(MBG) 3, and post-operative TIMI grade 3 was significantly higher in the combined treatment group than in the aspiration-only group(all P<0.001). There were 102 cas

关 键 词：血栓抽吸 冠状动脉内溶栓 ST段抬高型心肌梗死 微循环障碍 

分 类 号：R54[医药卫生—心血管疾病]