论文部分内容阅读
目的评估急性前壁ST段抬高心肌梗死(STEMI)患者施行冠状动脉介入治疗(PCI)前应用DiverCE血栓抽吸导管的效果。方法单中心前瞻性评估发病<12h、TIMI血流0～1级的急性前壁STEMI患者施行直接PCI前应用DiverCE血栓抽吸导管的有效性。主要终点是PCI后1h内ST段回落程度。结果164例患者入选本研究。DiverCE组与常规PCI组的年龄(55.3±13.0岁比56.1±14.0岁)、男性(88%比87%)、糖尿病(30%比28%)、既往冠心病(24%比23%)、症状发作到直接PCI时间(348±175min比350±181min)和应用血小板膜糖蛋白Ⅱb/Ⅲa抑制剂(10%比9%)等基线资料均匹配。DiverCE组术后1h内ST段回落率(59%比38%)、即刻TIMI3级血流(96%比80%)、心肌呈色3级血流(70%比46%)和慢血流或无复流率(7%比17%)明显优于常规PCI组(P<0.05)。术后1个月临床结果显示,左心室射血分数(0.54±0.11比0.52±0.13)有改善趋势,死亡(4%比4%)、再次心肌梗死(2%比1%)、靶血管重建(1%比1%)和卒中(1%比1%)差异无统计学意义(P>0.05)。结论与常规PCI比较,在前壁STEMI患者施行支架术前应用DiverCE血栓抽吸导管可以降低远端栓塞、促进ST段回落并改善心肌灌注。
Objective To evaluate the efficacy of DiverCE thrombus aspiration catheter before coronary intervention (PCI) in patients with acute anterior ST-segment elevation myocardial infarction (STEMI). METHODS Single-center prospective assessment of the efficacy of DiverCE thrombus aspiration catheters was performed prior to direct PCI in a prospective anterior STEMI patients with onset <12 h and TIMI flow grades 0 to 1. The primary endpoint was the degree of ST-segment fall within 1 h after PCI. Results 164 patients were enrolled in this study. Age (55.3 ± 13.0 vs 56.1 ± 14.0 years), men (88% vs 87%), diabetes (30% vs 28%), previous coronary heart disease (24% vs 23%), and symptoms Outbreaks matched baseline data with direct PCI (348 ± 175 min vs 350 ± 181 min) and with platelet glycoprotein IIb / IIIa inhibitors (10% vs 9%). ST-segment resolution (59% vs 38%), immediate TIMI grade 3 (96% -80%), myocardium grade 3 (70% vs 46%) and slow blood flow No reflow rate (7% vs 17%) was significantly better than the conventional PCI group (P <0.05). One month after surgery, the left ventricular ejection fraction (0.54 ± 0.11 vs. 0.52 ± 0.13) showed a trend of improvement, with death (4% vs 4%), myocardial infarction (2% vs 1%), and target revascularization (1% vs 1%) and stroke (1% vs 1%) had no significant difference (P> 0.05). Conclusion Compared with conventional PCI, DiverCE thrombus aspiration catheter can reduce distal embolism, promote ST segment depression and improve myocardial perfusion in patients with STEMI.