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目的:评价血栓抽吸治疗在急性ST段抬高心肌梗死(STEMI)直接经皮冠状动脉介入治疗术(PCI)中应用的安全性和有效性。方法:59例STEMI患者被随机分为血栓抽吸组和传统PCI组(对照组),对2组之间的冠状动脉造影结果(TIMI3级血流率、校正TIMI帧数、TMP分级)、心电图ST段回落百分比(sumSTR)和临床结果[肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)峰值、术后1周左室射血分数(LVEF)、6个月主要不良心血管事件]进行分析比较。结果:血栓抽吸组PCI后梗死相关动脉TIMI3级血流率、TMP3级及sumSTR>70%发生率均显著高于对照组,校正TIMI帧数、TMP0～1级及sumSTR<30%均显著低于对照组。血栓抽吸组CK、CK-MB峰值显著低于对照组,术后1周LVEF显著高于对照组。随访6个月主要不良心血管事件2组差异无统计学意义。结论:在急性STEMI直接PCI中应用血栓抽吸治疗是安全有效的,能够改善心肌灌注,降低心肌梗死面积,提高LVEF。
Objective: To evaluate the safety and efficacy of thrombus aspiration in the treatment of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing direct percutaneous coronary intervention (PCI). Methods: Fifty-nine patients with STEMI were randomly divided into thrombolysis group and conventional PCI group (control group). The coronary angiography results (TIMI grade 3, corrected TIMI frames, TMP grade), electrocardiogram ST-segment fall-off percentage (sumSTR) and clinical outcomes (creatine kinase (CK) and creatine kinase MB (CK-MB) peak at 1 week postoperative left ventricular ejection fraction (LVEF), 6 months, major adverse cardiac Vascular events] for analysis and comparison. Results: The TIMI grade 3 blood flow rate, TMP3 grade and sumSTR> 70% in the thrombolysis group after PCI were significantly higher than those in the control group. The corrected TIMI frame number, TMP0 ~ 1 level and sumSTR <30% In the control group. The peak values of CK and CK-MB in thrombus aspiration group were significantly lower than those in control group, and the LVEF in 1 week after operation was significantly higher than that in control group. The 6-month follow-up of major adverse cardiovascular events did not show significant difference between the two groups. Conclusion: Thrombus aspiration in acute STEMI direct PCI is safe and effective, which can improve myocardial perfusion, reduce infarct size and increase LVEF.