摘要
目的探讨直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)应用血栓抽吸对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者心肌灌注及临床预后的影响。方法采用回顾性研究方法,纳入于河北省人民医院行PPCI的STEMI患者446例。依据术中是否应用血栓抽吸分为非血栓抽吸组(230例)和血栓抽吸组(216例)。收集临床资料和术后慢血流/无复流发生情况,记录术后12个月内主要不良心血管事件(包括心原性死亡、再发心肌梗死、靶血管血运重建)和缺血性脑卒中发生情况。结果与非血栓抽吸组相比,血栓抽吸组造影显示心肌梗死溶栓治疗(thrombolysis in myocardial infraction,TIMI)血栓负荷≥4级、术前TIMI血流<3级及术中替罗非班、尿激酶原的使用率更高,术中造影剂用量更多,而多支病变的比率较低,差异有统计学意义(P<0.05)。二元Logistic回归分析显示造影TIMI血栓负荷≥4级、术前TIMI血流<3级是PPCI术中使用血栓抽吸的影响因素(P<0.05)。年龄(OR=1.03,95%CI:1.004~1.056,P=0.023)、造影剂用量(OR=1.004,95%CI:1~1.008,P=0.047)是发生无复流的独立危险因素;发生慢血流/无复流组患者较正常血流组患者中术中行血栓抽吸的比率低,多因素分析显示在全体人群中血栓抽吸与慢血流/无复流无关。Killip≥2级和左主干病变是主要不良心血管事件(major adverse cardiovascular events,MACE)的独立危险因素,而他汀类药物是MACE的保护性因素;Killip≥2级是心原性死亡的独立危险因素,而他汀类药物和射血分数是心原性死亡的保护性因素。血栓抽吸是高血栓负荷人群术后发生无复流的保护性因素;年龄、造影剂用量是高血栓负荷人群发生无复流的危险因素。高血栓负荷人群两组术后12个月的MACE、心原性死亡、再发心肌梗死、靶血管重建及缺血性脑卒中发生率差异无统计学意义(P>0.05)。高血栓负�
Objective To investigate the effect of thrombus aspiration during primary percutaneous coronary intervention(PPCI)in patients with ST-segment elevation myocardial infarction(STEMI)on myocardial reperfusion and clinical prognosis.Methods We retrospectively analyzed the clinical data of STEMI patients who underwent PPCI in Hebei General Hospital.Patients were divided into non-thrombus aspiration group(n=230)and thrombus aspiration group(n=216).Clinical data and incidence of postoperative slow blood flow/no-reflow were collected,and major adverse cardiovascular events(MACE),including cardiac death,re-myocardial infraction,target vessal revascularization,and stroke were recorded during 12-month follow-up.Results Compared with non-thrombus aspiration group,thrombus aspiration group showed higher use rate of thrombolysis in myocardial infarction(TIMI)thrombus load≥grade 4,preoperative TIMI blood flow<grade 3,intraoperative tirofiban and prourokinase,more intraoperative contrast agent,and lower rate of multivessel lesions(P<05).Binary Logistic regression analysis showed that TIMI thrombus load≥grade 4 and TIMI blood flow<grade 3 were the influencing factors of thrombus aspiration during PPCI(P<0.05).Age(OR=1.03,95%CI:1.004-1.056,P=0.023)and contrast agent dosage(OR=1.004,95%CI:1-1.008,P=0.047)were independent risk factors for no-reflow.The rate of thrombus aspiration in patients with slow flow/no-reflow was lower than that in patients with normal blood flow.Multivariate analysis showed that thrombus aspiration was not associated with slow flow/no-reflow in the whole population.Killip≥2 and left main coronary artery disease were independent risk factors for MACE,while statins were protective factors for MACE;Killip≥2 was an independent risk factor for cardiac death,while statins and ejection fraction were protective factors for cardiac death.Thrombus aspiration was a protective factor for no-reflow in patients with high thrombus load;Age and dosage of contrast agent were the risk factors of no-reflow in the popul
作者
张飞飞
宋学莲
谢悦陶
刘立天
党懿
齐晓勇
ZHANG Fei-fei;SONG Xue-lian;XIE Yue-tao;LIU Li-tian;DANG Yi;QI Xiao-yong(Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, China)
出处
《河北医科大学学报》
CAS
2021年第7期770-778,共9页
Journal of Hebei Medical University
基金
河北省医学科学研究课题计划项目(20210532)。
关键词
心肌梗死
经皮冠状动脉介入治疗
血栓切除术
myocardial infraction
percutaneous coronary intervention
thrombectomy
