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目的评估血栓抽吸(TA)后行直接冠状动脉支架置入术对ST段抬高心肌梗死(STEMI)患者预后的影响。方法纳入2011年12月至2014年7月因STEMI入院且发病在12 h内并行直接冠状动脉支架置入术、符合入选标准的患者443例,其中TA后直接置入支架患者113例(TA组),TA后球囊预扩张(BP)患者330例(TA+BP组)。主要终点:12个月主要不良心血管事件(MACE)的发生情况;次要终点:靶血管远段栓塞和支架内血栓形成。结果所有患者均成功置入支架。TA组患者术后60 min内ST段回落>50%的比例(69.0%比51.8%,P=0.001)显著大于TA+BP组,差异有统计学意义。TA组TIMI血流≥Ⅱ级在TA后即刻(76.1%比65.8%,P=0.043)、支架置入前/BP后(76.1%比62.4%,P=0.012)、支架置入后(92.0%比84.5%,P=0.042)及手术结束前(95.6%比91.2%,P=0.033)比例显著大于TA+BP组,差异均有统计学意义;而术中因TIMI血流欠佳或血栓负荷仍较重而补救性使用血小板糖蛋白Ⅱb/Ⅲa抑制药的比例(16.8%比27.6%,P=0.026)及靶血管远段栓塞的比例(6.2%比13.3%,P=0.040)显著低于TA+BP组,差异亦均有统计学意义。虽然两组患者在住院期间和随访12个月的MACE发生率比较差异无统计学意义,但TA组患者总MACE发生率(5.3%比11.8%,P=0.041)显著低于TA+BP组,差异有统计学意义。结论TA后行直接冠状动脉支架置入术可改善STEMI患者最终的心肌再灌注,从而改善患者短期临床预后。
Objective To evaluate the effect of direct coronary stent implantation on the prognosis of patients with ST-elevation myocardial infarction (STEMI) after thrombus aspiration (TA). Methods A total of 443 eligible patients were enrolled in this study. Among them, 113 patients (TA group) were treated with STEMI immediately after stenting ), And 330 patients with pre-dilatation balloon (TA) after TA (TA + BP group). Primary endpoint: incidence of major adverse cardiovascular events (MACE) at 12 months; secondary endpoint: distal target vessel embolism and stent thrombosis. Results All patients were successfully placed in stents. The percentage of ST segment regression> 50% within 60 min after operation in the TA group (69.0% vs 51.8%, P = 0.001) was significantly higher than that in the TA + BP group. The difference was statistically significant. The TIMI blood flow grade ≧ Ⅱ in TA group immediately after TA (76.1% vs 65.8%, P = 0.043), before / after stent implantation (76.1% vs. 62.4%, P = 0.012) (84.5%, P = 0.042) and before operation (95.6% vs 91.2%, P = 0.033) were significantly higher than those in TA + BP group, but the difference was statistically significant The rates of platelet glycoprotein IIb / IIIa inhibitors (16.8% vs. 27.6%, P = 0.026) and target vessel distal embolism (6.2% vs. 13.3%, P = 0.040) were still significantly lower TA + BP group, the differences were also statistically significant. Although there was no significant difference in the incidence of MACE between the two groups during hospitalization and 12 months of follow-up, the overall incidence of MACE in the TA group was significantly lower than that in the TA + BP group (5.3% vs 11.8%, P = 0.041) The difference was statistically significant. Conclusions Direct posterior coronary stenting with TA can improve the final myocardial reperfusion in STEMI patients and improve the short-term clinical prognosis.