临床内科杂志 ›› 2019, Vol. 36 ›› Issue (11): 739-742.doi: 10.3969/j.issn.1001-9057.2019.11.007

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不同缺血时间对急性ST段抬高型心肌梗死患者介入血栓抽吸获益程度的影响

  

  • 出版日期:2019-11-15 发布日期:2019-11-30

Effect of different ischemic time on benefit of interventional thrombus aspiration in patients with acute ST-segment elevation myocardial infarction

  • Online:2019-11-15 Published:2019-11-30

摘要: 目的 探讨不同缺血时间对急性ST段抬高型心肌梗死(STEMI)患者介入血栓抽吸(TA)获益程度的影响。方法 纳入STEMI且接受经皮冠状动脉介入治疗(PCI)患者198例,其中109例接受TA治疗患者作为TA组,89例未接受TA治疗患者作为对照组。根据心肌总缺血时间(TTT)将患者分为早期PCI组(TTT≤4h)72例和非早期PCI组(TTT>4h)126例。采用心肌梗死溶栓试验(TIMI)血流分级评价患者心外膜冠脉血流情况,并分析TA和TTT对STEMI患者PCI预后的影响。结果 PCI术前TA组TIMI血流分级0级患者比例高于对照组(P<0.05)。早期PCI组接受TA患者比例高于非早期PCI组,而发生主要不良心血管事件(MACE)患者比例低于非早期PCI组(P<0.05)。STEMI患者接受TA治疗与MACE的发生呈负相关(P<0.001),而TTT与PCI术后全因死亡和MACE的发生均呈正相关(P<0.001)。Logistic回归分析结果显示,对于所有STEMI患者,TTT>4h明显增加MACE的发生风险,接受TA治疗降低MACE的发生风险(P<0.05)。对于TA组患者,TTT>4h增加全因死亡和MACE的发生风险(P<0.05)。结论 对于接受PCI时行TA治疗的STEMI患者,TTT>4h增加其全因死亡和MACE的发生风险。

关键词: 不同缺血时间; 急性ST段抬高型心肌梗死; 介入血栓抽吸; 获益程度

Abstract: Objective To explore the effect of different ischemic time on benefit of interventional thrombus aspiration(TA) in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 198 patients with STEMI who received percutaneous coronary intervention(PCI) were concluded.The 109 patients receiving TA were selected as TA group,and 89 patients who did not reveive TA were selected as control group.Patients were divided into early PCI group[total myocardial ischemia time(TTT)≤4h,72 cases) and non-early PCI group(TTT>4h,126 cases) according to TTT.Epicardial coronary flow was evaluated by myocardial infarction thrombolysis(TIMI) blood flow grading.The effect of TA and TTT on PCI prognosis in patients with STEMI was analyzed.Results The proportion of patients with TIMI blood flow grading 0 in TA group before PCI was higher than that in control group(P<0.05).The proportion of patients receiving TA in early PCI group was higher than that in nonearly PCI group,while the proportion of patients who occurred major adverse cardiovascular events(MACE) was lower than that in nonearly PCI group(P<0.05).There was a negative correlation between TA treatment and MACE in patients with STEMI(P<0.001),while TTT was positively correlated with all-cause death and MACE after PCI(P<0.001).Logistic regression analysis showed that TTT>4h significantly increased the risk of MACE,and TA treatment reduced the risk of MACE for all STEMI patients(P<0.05).For the patients in TA group,TTT>4h increased the risk of death and all-cause MACE(P<0.05).Conclusion For STEMI patients receiving TA treatment during PCI,TTT>4h increases the risk of death and all-cause MACE.

Key words: Different ischemic time; Acute ST-segment elevation myocardial infarction; Interventional thrombus aspiration; Benefit degree