Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myoc...Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction （STEMI）. This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group （97.22% vs. 87.04%, X2=7.863, P=0.049）. The peak of CK-MB （83.9 （68.9-310.5） U/L vs. 126.1 （74.7-356.7） U/L, P=0.034） and Tnl （42.7 （14.7-113.9） ng/ml vs. 72.5 （59.8-135.3） ng/ml, FMD.029） were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, （45.7±8.3）% to （42.9±12.1）%, t=1.98, P=0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference （Log-rank X2=2.865, P=0.09）. There was no statistical difference in any bleeding events between the two groups.Conclusions Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.展开更多
目的观察急性心肌梗死(AMI)伴高血栓负荷患者急诊介入治疗中运用经桡动脉途径行血栓抽吸和冠状动脉(冠脉)内注入替罗非班对恢复心肌再灌注及近期临床疗效的影响。方法选择2016年1月至2019年1月安徽省皖南医学院附属芜湖市第二人民医院...目的观察急性心肌梗死(AMI)伴高血栓负荷患者急诊介入治疗中运用经桡动脉途径行血栓抽吸和冠状动脉(冠脉)内注入替罗非班对恢复心肌再灌注及近期临床疗效的影响。方法选择2016年1月至2019年1月安徽省皖南医学院附属芜湖市第二人民医院收治的AMI伴高血栓负荷急诊行桡动脉途径冠脉介入治疗患者108例作为研究对象。68例急诊经皮冠脉介入治疗(PCI)行冠脉内注射替罗非班(非抽吸组);40例急诊PCI行导管血栓抽吸联合冠脉内注射替罗非班(抽吸组)。比较两组心肌组织再灌注水平、心功能情况、术后N末端脑钠肽前体(NT-proBNP)、出血、住院期间及术后30 d心血管事件(MACE)的发生率。结果与非抽吸组比较,抽吸组罪犯血管心肌梗死溶栓治疗临床试验(TIMI)3级血流发生率明显升高〔95.0%(38/40)比58.8%(40/68)〕,远端栓塞发生率〔0%(0/40)比8.8%(6/68)〕、术后心肌再灌注分级(TMP)<3级比例〔0%(0/40)比11.8%(8/68)〕和NT-proBNP水平(ng/L:1082.5±146.9比3125.5±182.6)均明显降低,差异均有统计学意义(均P<0.05)。抽吸组术后出血发生率〔2.5%(1/40)比4.4%(3/68)〕、院内MACE发生率〔0%(0/40)比1.5%(1/68)〕、院内病死率〔0%(0/40)比1.5%(1/68)〕、术后30 d MACE发生率〔0%(0/40)比1.5%(1/68)〕和术后30 d病死率〔0%(0/40)比1.5%(1/68)〕比较差异均无统计学意义(均P>0.05)。两组均无院内再次PCI病例。结论在AMI伴高血栓负荷患者中,急诊行桡动脉途径PCI中运用血栓抽吸联合替罗非班可显著改善AMI患者心肌再灌注和心功能,降低无复流,但不增加出血和近期主要不良MACE的发生率。展开更多
目的研究血栓抽吸联合直接经皮冠状动脉介入治疗（PCI）对老年急性ST段抬高型心肌梗死（STEMI）患者的疗效。方法收集荆门市第一人民医院2011年1月至2013年12月因急性STEMI行直接PCI治疗的老年患者108例,年龄60~75岁。分为两组,对照组68...目的研究血栓抽吸联合直接经皮冠状动脉介入治疗（PCI）对老年急性ST段抬高型心肌梗死（STEMI）患者的疗效。方法收集荆门市第一人民医院2011年1月至2013年12月因急性STEMI行直接PCI治疗的老年患者108例,年龄60~75岁。分为两组,对照组68例,行单纯PCI术;联合组40例,血栓抽吸联合PCI治疗。比较两组患者的基础资料、术后即刻冠状动脉造影、术后校正TIMI帧数（CTFC）以及住院期间和出院后6个月随访情况。结果 （1）两组间基线一致,具有可比性。（2）联合组术后TIMI血流分级、TIMI血流3级率、术后90 min ST段回落〉50%的比率均较对照组高（P〈0.05）,而术后无复流率、CTFC明显低于对照组（P〈0.05）;住院期间死亡率未见明显差异（P〉0.05）。（3）随访6个月后,两组患者全因死亡率、主要不良心脏事件及心绞痛再次住院率均未见明显差异（P〉0.05）,但联合组左心室射血分数较对照组明显增高（P〈0.05）。结论血栓抽吸可有效减轻老年急性STEMI患者冠状动脉内的血栓负荷,明显改善PCI术后心肌组织微循环的灌注和心功能。展开更多
文摘Background We developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery （IRA） bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction （STEMI）. This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group （97.22% vs. 87.04%, X2=7.863, P=0.049）. The peak of CK-MB （83.9 （68.9-310.5） U/L vs. 126.1 （74.7-356.7） U/L, P=0.034） and Tnl （42.7 （14.7-113.9） ng/ml vs. 72.5 （59.8-135.3） ng/ml, FMD.029） were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, （45.7±8.3）% to （42.9±12.1）%, t=1.98, P=0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference （Log-rank X2=2.865, P=0.09）. There was no statistical difference in any bleeding events between the two groups.Conclusions Thrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.
文摘目的观察急性心肌梗死(AMI)伴高血栓负荷患者急诊介入治疗中运用经桡动脉途径行血栓抽吸和冠状动脉(冠脉)内注入替罗非班对恢复心肌再灌注及近期临床疗效的影响。方法选择2016年1月至2019年1月安徽省皖南医学院附属芜湖市第二人民医院收治的AMI伴高血栓负荷急诊行桡动脉途径冠脉介入治疗患者108例作为研究对象。68例急诊经皮冠脉介入治疗(PCI)行冠脉内注射替罗非班(非抽吸组);40例急诊PCI行导管血栓抽吸联合冠脉内注射替罗非班(抽吸组)。比较两组心肌组织再灌注水平、心功能情况、术后N末端脑钠肽前体(NT-proBNP)、出血、住院期间及术后30 d心血管事件(MACE)的发生率。结果与非抽吸组比较,抽吸组罪犯血管心肌梗死溶栓治疗临床试验(TIMI)3级血流发生率明显升高〔95.0%(38/40)比58.8%(40/68)〕,远端栓塞发生率〔0%(0/40)比8.8%(6/68)〕、术后心肌再灌注分级(TMP)<3级比例〔0%(0/40)比11.8%(8/68)〕和NT-proBNP水平(ng/L:1082.5±146.9比3125.5±182.6)均明显降低,差异均有统计学意义(均P<0.05)。抽吸组术后出血发生率〔2.5%(1/40)比4.4%(3/68)〕、院内MACE发生率〔0%(0/40)比1.5%(1/68)〕、院内病死率〔0%(0/40)比1.5%(1/68)〕、术后30 d MACE发生率〔0%(0/40)比1.5%(1/68)〕和术后30 d病死率〔0%(0/40)比1.5%(1/68)〕比较差异均无统计学意义(均P>0.05)。两组均无院内再次PCI病例。结论在AMI伴高血栓负荷患者中,急诊行桡动脉途径PCI中运用血栓抽吸联合替罗非班可显著改善AMI患者心肌再灌注和心功能,降低无复流,但不增加出血和近期主要不良MACE的发生率。
文摘目的研究血栓抽吸联合直接经皮冠状动脉介入治疗（PCI）对老年急性ST段抬高型心肌梗死（STEMI）患者的疗效。方法收集荆门市第一人民医院2011年1月至2013年12月因急性STEMI行直接PCI治疗的老年患者108例,年龄60~75岁。分为两组,对照组68例,行单纯PCI术;联合组40例,血栓抽吸联合PCI治疗。比较两组患者的基础资料、术后即刻冠状动脉造影、术后校正TIMI帧数（CTFC）以及住院期间和出院后6个月随访情况。结果 （1）两组间基线一致,具有可比性。（2）联合组术后TIMI血流分级、TIMI血流3级率、术后90 min ST段回落〉50%的比率均较对照组高（P〈0.05）,而术后无复流率、CTFC明显低于对照组（P〈0.05）;住院期间死亡率未见明显差异（P〉0.05）。（3）随访6个月后,两组患者全因死亡率、主要不良心脏事件及心绞痛再次住院率均未见明显差异（P〉0.05）,但联合组左心室射血分数较对照组明显增高（P〈0.05）。结论血栓抽吸可有效减轻老年急性STEMI患者冠状动脉内的血栓负荷,明显改善PCI术后心肌组织微循环的灌注和心功能。
