血栓抽吸在急性STEMI患者PPCI术中的应用研究

摘要

目的：评估急性ST段抬高心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PPCI）中应用血栓抽吸（TA）对术后TIMI血流、左室收缩功能和临床预后的影响。方法回顾天津市胸科医院心内科2013年1月—2015年3月连续收治的STEMI并行PPCI的患者664例，根据术中是否应用血栓抽吸，分为抽吸组和对照组。2组临床基线情况、冠状动脉造影（CAG）病变情况及PPCI相关指标差异均无统计学意义。术后随访12个月，评价1个月及12个月时血栓抽吸对术后TIMI血流、左室收缩功能及预后的影响。结果抽吸组术后TIMI血流、术后1周左室射血分数均高于对照组（P＜0.05）。随访1个月时2组各主要不良心脏事件（MACE）及总MACE发生率比较差异无统计学意义。12个月时2组心源性死亡、再发心肌梗死、新发或加重心力衰竭发生率比较差异无统计学意义，抽吸组再发心绞痛、总MACE发生率低于对照组。抽吸组无MACE生存情况优于对照组。结论 STEMI患者PPCI术中应用血栓抽吸可以进一步改善术后TIMI血流和左室收缩功能，减少术后12个月内再发心绞痛的发作，但对其他MACE无明显获益。%Objective To explore the clinical efficacy and outcomes of thrombus aspiration in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PPCI). Methods A total of 664 cases of STEMI patients undergoing PPCI from Tianjin Chest Hospital from January 2013 to March 2015 were retrospectively analyzed. Patients were divided into two groups:primary PCI after thrombus aspiration group and conventional primary PCI without thromobus aspiration group. The base-line clinical characteristics, and the procedure of percutaneous coronary intervention were similar between two groups. The TIMI flow, LVEF, one-month outcomes and 12-month outcomes were compared between two groups. Results There were significant higher TIMI flow, LVEF in primary PCI after thrombus aspiration group than those of conventional primary PCI without thromobus aspiration group (P<0.05). At one-month follow-up, there were no significant differences in major adverse cardiac events (MACE) between the two groups. At 12-month follow- up, there were no significant differences in cardiovascular death, recurrent myocardial infarction and new hospitalization between two groups. The incidence of recurrent angina was significantly higher in non-aspiration group than that in aspiration group (P<0.05). There were the better survival functions without MACE in aspiration group than that of control group. Conclusion Thrombus aspiration, as an adjunctive method to primary PCI for STEMI, may improve TIMI flow, have beneficial effects on LVEF and reduce the incidence of recurrent angina at 12-month follow up.