【摘要】 目的评估急性前壁ST段抬高心肌梗死(STEMI)患者施行冠状动脉介入治疗(PCI)前应用DiverCE血栓抽吸导管的效果。方法单中心前瞻性评估发病<12h、TIMI血流0～1级的急性前壁STEMI患者施行直接PCI前应用DiverCE血栓抽吸导管的有效性。主要终点是PCI后1h内ST段回落程度。结果164例患者入选本研究。DiverCE组与常规PCI组的年龄(55.3±13.0岁比56.1±14.0岁)、男性(88%比87%)、糖尿病(30%比28%)、既往冠心病(24%比23%)、症状发作到直接PCI时间(348±175min比350±181min)和应用血小板膜糖蛋白Ⅱb/Ⅲa抑制剂(10%比9%)等基线资料均匹配。DiverCE组术后1h内ST段回落率(59%比38%)、即刻TIMI3级血流(96%比80%)、心肌呈色3级血流(70%比46%)和慢血流或无复流率(7%比17%)明显优于常规PCI组(P<0.05)。术后1个月临床结果显示,左心室射血分数(0.54±0.11比0.52±0.13)有改善趋势,死亡(4%比4%)、再次心肌梗死(2%比1%)、靶血管重建(1%比1%)和卒中(1%比1%)差异无统计学意义(P>0.05)。结论与常规PCI比较,在前壁STEMI患者施行支架术前应用DiverCE血栓抽吸导管可以降低远端栓塞、促进ST段回落并改善心肌灌注。更多还原

【Abstract】 Objective To compare the effect of adjunctive thrombectomy using Diver CE device(Invatec,Italy)before percutaneous coronary intervention(PCI)versus conventional PCI in patients with anterior myocardial infarction for <12 h and Thrombolysis In Myocardial Infarction(TIMI)flow grade 0 to 1.Methods We conducted a prospective,single-center study in patients with anterior myocardial infarction <12 h and initial TIMI flow grade 0 to 1 who were treated with primary PCI.The magnitude of ST-segment resolution 1 h after PCI was the primary end point.Results A total of 164 patients entered into this study.Both groups were comparable by age(55.3±13.0 years vs.56.1±14.0 years),males(88% vs.87%),diabetes(30% vs.28%),previous coronary artery disease(24%vs.23%),onset-to-angiogram(348±175 min vs.350±181 min),and glycoprotein IIb/IIIa inhibitor use(10% vs.9%).The magnitude of ST-segment resolution was greater in the Diver CE group compared with the conventional PCI group as ST-segment resolution >70%(59% vs.38%,P<0.05)and TIMI flow grade 3 was obtained in 96% vs.80% respectively(P<0.05).Difference in myocardial blush grade 3(70% vs.46%,P<0.05)and slow flow/no reflow(7% vs.17%,P<0.05)were observed between these two groups.One-month clinical outcome was comparable(death,4% vs.4%;myocardial infarction,2% vs.1%;target vessel revascularization,1% vs.1%;stroke,1% vs.1%,respectively)although there was a tendency of improved left ventricle injection fraction in the Driver CE group(0.54±0.11 vs.0.52±0.13).Conclusion Removing thrombus burden with Diver CE device before stenting leads to better myocardial reperfusion,as illustrated by a reduced risk of distal embolization and better ST-segment resolution.更多还原