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目的观察因血栓高负荷未能行初次经皮冠状动脉介入治疗(PCI)的急性ST段抬高心肌梗死患者围术期抗栓治疗对择期PCI的影响。方法回顾性分析8例急性ST段抬高心肌梗死患者初次行冠状动脉造影术,因靶血管血栓高负荷不能行支架置入术。分析所有患者围术期抗栓治疗方案、术中处理方案及随访情况。结果所有8例患者均为男性,平均年龄(51.25±10.81)岁。吸烟史是最常见的危险因素。右冠状动脉大量血栓堵塞导致急性下壁心肌梗死最多见。3例患者未行PCI,1例仅行单纯血栓抽吸,4例患者行血栓抽吸及球囊扩张术。7例患者术中、术后均给予替罗非班治疗;术后6例患者给予低分子肝素抗凝;7例患者常规双联抗血小板治疗(阿司匹林100 mg、每日1次+氯吡格雷75 mg、每日1次或替格瑞洛90 mg、每日1次),1例患者阿司匹林剂量增加至200 mg,氯吡格雷增加至每日2次。平均(29.00±23.25)d后复查冠状动脉造影,2例患者因仍存在血栓高负荷,未尝试行PCI;1例患者因血管扭曲,球囊不能送至闭塞病变处,未能成功置入支架;2例患者因血栓负荷过重,球囊扩张后,未行支架置入术;3例患者成功行支架置入术。结论急性ST段抬高心肌梗死患者因靶血管血栓高负荷初次开通血管失败,常规抗栓治疗方案对血栓高负荷的清除作用有限,血栓完全机化、择期PCI的时机尚不清楚,仍需进一步研究探讨。
Objective To investigate the effect of perioperative antithrombotic therapy on elective PCI in patients with acute ST-segment elevation myocardial infarction who failed to undergo primary percutaneous coronary intervention (PCI) due to high thrombus loading. Methods A retrospective analysis of 8 patients with acute ST-elevation myocardial infarction patients underwent coronary angiography for the first time, due to high target vessel thrombosis can not be stenting. All patients underwent perioperative antithrombotic therapy, intraoperative management and follow-up. Results All 8 patients were male, mean age (51.25 ± 10.81) years. Smoking history is the most common risk factor. A large number of thrombosis of the right coronary artery blocked the most common acute myocardial infarction. Three patients had no PCI, one had simple thrombus aspiration, and four had thrombus aspiration and balloon dilatation. Seven patients were treated with tirofiban intraoperatively and postoperatively. Six patients underwent anticoagulant therapy with low molecular weight heparin. Seven patients received conventional dual antiplatelet therapy (aspirin 100 mg, once daily plus clopidogrel 75 mg once daily or ticagrelor 90 mg once daily), one aspirin dose was increased to 200 mg and clopidogrel was increased to twice daily. Coronary angiography was performed after a mean of (29.00 ± 23.25) days. Two patients were still undergoing PCI due to the high load of thrombus. One patient suffered from vascular distortions, and the balloon could not be delivered to the occluded lesion. Two patients were overloaded with thrombus. After balloon dilatation, stent placement was not performed. Three patients underwent stent placement successfully. Conclusion The patients with acute ST-segment elevation myocardial infarction have failed to open the blood vessels for the first time due to high load of target vessel thrombosis. The effect of conventional antithrombotic therapy on the removal of thrombus high load is limited. The timing of complete thrombosis and elective PCI remains unclear. Research and discussion.