基于定量血流分数算法评价血栓抽吸术对高血栓负荷STEMI患者PCI治疗后冠状动脉功能及微循环的影响  

Using Quantitative Flow Fraction Algorithm to Evaluate Effectiveness of Throm⁃bus Aspiration on Coronary Function and Microcirculation Following PCI in Patients with STEMI with High Thrombus Burden

作　　者：徐生辉 杨醒[1] 田静茹 李希大 刘吉欣 李莹 李光 周颖玲 董豪坚 XU Shenghui;YANG Xing;TIAN Jingru;LI Xida;LIU Jixin;LI Ying;LI Guang;ZHOU Yingling;DONG Haojian(Department of Emergency,Guangdong Provincial People′s Hospital Zhuhai Hospital(Zhuhai Golden Bay Center Hospital),Zhuhai,Guangdong 519090,China;Department of Cardiology,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Department of Cardiology,Linzhi People′s Hos-pital of Xizang,Linzhi,Xizang 860000,China;Department of Cardiology,Jiexi County People′s Hospital,Jiexi,Guangdong 522000,China)

机构地区：[1]广东省人民医院珠海医院(珠海市金湾中心医院)急诊科,广东珠海519090 [2]南方医科大学附属广东省人民医院(广东省医学科学院)心内科,广州510080 [3]西藏林芝市人民医院心内科,西藏林芝860000 [4]揭西县人民医院心内科,广东揭阳522000

出　　处：《岭南心血管病杂志》2024年第1期1-7,共7页South China Journal of Cardiovascular Diseases

基　　金：珠海市医学科研基金项目(项目编号:ZH24013310210054PWC);西藏自治区科技计划项目(项目编号:XZ202201ZY0051G)。

摘　　要：目的基于定量血流分数(quantitative flow fraction,QFR)、血管的微血管阻力(angiographic microvascular resistance,AMR)、冠状动脉血流速度(coronary flow velocity,CFV)等指标,评价高血栓负荷ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者在急诊经皮冠状动脉介入(primary percutaneous coronary intervention,PPCI)治疗中使用血栓抽吸术,能否改善冠状动脉功能及微循环。方法这是一项多中心、前瞻、观察性研究(ChiCTR1800019923),纳入了3个中心自2015年10月至2021年4月行PPCI治疗的高血栓负荷STEMI患者,按介入治疗中是否行血栓抽吸,分为血栓抽吸组及常规PCI治疗组,测量并对比术后QFR、AMR、冠状动脉微血管功能障碍(coronary microvascular dysfunction,CMD)发生率、心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流等级、TIMI心肌灌注分级(TIMI myocardial perfusion grading,TMPG)血流等级、血流异常发生率,随访术后3个月内主要不良心血管事件(main adverse cardiovascular events,MACE),包括全因死亡、再发心肌梗死、靶血管再次血运重建。结果共有953例患者进入筛查,最终885例患者符合入组。男性743例,女性142例,其中血栓抽吸组241例(27.2%),常规PCI治疗组644例(72.8%)。血栓抽吸组及常规PCI治疗组之间的术后QFR、AMR、CFV、CMD发生率、血流异常发生率、TIMI及TMPG血流等级比较,差异无统计学意义(P>0.05)。进行多因素匹配后,常规PCI治疗组患者的CMD发生率(70.7%vs.55.1%,P=0.001)、血流异常发生率(23.1%vs.13.3%,P=0.01)均高于血栓抽吸组,差异有统计学意义;但两组患者治疗后QFR、AMR、CFV、TIMI及TMPG血流等级,差异无统计学意义(P>0.05)。Kaplan-Meier曲线显示,两组患者治疗后3个月内MACE发生率比较,差异无统计学意义(P>0.05)。结论血栓抽吸术可减少高血栓负荷STEMI患者PPCI治疗后CMD发生率,有助于改善其术后冠状动脉功能及微循环状态。Objectives To evaluate whether thrombus aspiration in patients with ST-segment elevation myocardial infarc-tion(STEMI)with high thrombus burden could improve coronary function and microcirculation based on quantitative flow fraction(QFR),angiographic microvascular resistance(AMR),and coronary flow velocity(CFV)during primary percutaneous coronary intervention(PPCI).Methods This was a multicenter prospective observational study(ChiC-TR1800019923).Patients diagnosed with STEMI with high thrombus burden were recruited in three percutaneous coro-nary intervention(PCI)centers from October 2015 to April 2021.According to whether thrombus aspiration was per-formed during PCI,the patients were divided into thrombus aspiration group and standard PCI group.The parameters were recorded and analyzed between the two groups including QFR,AMR,incidence of coronary microvascular dysfunc-tion(CMD),thrombolysis in myocardial infarction(TIMI)flow grade,TIMI myocardial perfusion grading(TMPG)flow grade,incidence of blood flow anomalies.At the time point of three months after procedure,telephone follow-up was per-formed about the main adverse cardiovascular events(MACE),including all-cause death,recurrent myocardial infarc-tion,and revascularization of the target vessel blood.Results A total of 953 patients were screened and 885 patients were enrolled.There were 743 males and 142 females,including 241(27.2%)in the thrombus aspiration group and 644(72.8%)in standard PCI group.There was no significant differences in QFR,AMR,CFV,the incidence of CMD and blood flow anomalies,TIMI flow grades,and TMPG flow grades following PCI between thrombus aspiration group and standard PCI group(P>0.05).After multivariate matching,the incidence of CMD(70.710.7%vs.55.1%,P=0.001)and the incidence of blood flow anomalies(23.1%vs.13.3%,P=0.01)in standard PCI group were all significantly higher than those in thrombus aspiration group.However,there were no significant differences in QFR,AMR,CFV,TIMI and TMPG flow grade following PCI between the two groups(P

关 键 词：心肌梗死 高血栓负荷 血栓抽吸 定量血流分数 

分 类 号：R542.22[医药卫生—心血管疾病]