取栓治疗急性心肌梗死的疗效-特别关注根据不同相关梗死动脉的疗效。

Efficacy of thrombectomy for acute myocardial infarction-Special focus on its efficacy according to different infarct-related arteries.

机构信息

Department of Cardiology, Chiba Cardiovascular Center, 575 Tsurumai, Ichihara, Chiba 290-0512, Japan.

出版信息

J Cardiol. 2010 Mar;55(2):189-95. doi: 10.1016/j.jjcc.2009.10.007. Epub 2009 Dec 3.

DOI:10.1016/j.jjcc.2009.10.007

PMID:20206071

Abstract

BACKGROUND

The efficacy of thrombectomy during percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) has not yet been fully evaluated. The aim of this retrospective study was to evaluate the usefulness of manual thrombectomy for STEMI and to clarify whether different infarct-related arteries (IRAs) influence the efficacy of thrombectomy.

METHODS AND RESULTS

We enrolled 183 patients with STEMI who underwent PCI within 24h after onset between October 2001 and January 2004. We divided these patients into 2 groups, namely 88 patients who had undergone PCI after manual thrombectomy (Th+ group) and 95 patients who were treated with PCI alone (Th- group). The Th+ group had lower incidences of distal embolization and no-reflow phenomenon than the Th- group (6.8% vs. 27.4%, p=0.0003; and 5.7% vs. 23.2%, p=0.0009, respectively). The percentage of complete ST-segment resolution (STR) after PCI and left ventricular ejection fraction 6 months after the procedure were significantly higher in the Th+ group (43.2% vs. 20%, p=0.002; and 60.1% vs. 54.8%, p=0.004, respectively). Regarding different IRAs, the percentage of complete STR was significantly higher in patients with proximal left anterior descending coronary artery (LAD) and right coronary artery (RCA) lesions in the Th+ group (37.5% vs. 9.7%, p<0.05; and 59.5% vs. 30.3%, p<0.05, respectively). Incidences of adverse events were similar in both groups.

CONCLUSIONS

Manual thrombectomy for STEMI can improve myocardial reperfusion after PCI and left ventricular function late after the procedure. With respect to different IRAs, manual thrombectomy for STEMI is more effective in proximal LAD and RCA lesions.

摘要

背景

经皮冠状动脉介入治疗（PCI）治疗 ST 段抬高型急性心肌梗死（STEMI）的血栓切除术疗效尚未得到充分评估。本回顾性研究旨在评估手动血栓切除术治疗 STEMI 的有效性，并阐明不同梗死相关动脉（IRA）是否会影响血栓切除术的疗效。

方法和结果

我们纳入了 183 例发病 24 小时内接受 PCI 的 STEMI 患者，这些患者于 2001 年 10 月至 2004 年 1 月间接受治疗。我们将这些患者分为两组，即接受手动血栓切除术后行 PCI 的 88 例患者（Th+组）和单独接受 PCI 的 95 例患者（Th-组）。Th+组的远端栓塞和无复流现象发生率低于 Th-组（6.8%比 27.4%，p=0.0003；5.7%比 23.2%，p=0.0009）。PCI 后完全 ST 段缓解（STR）的比例和术后 6 个月的左心室射血分数在 Th+组中明显更高（43.2%比 20%，p=0.002；60.1%比 54.8%，p=0.004）。关于不同的 IRA，Th+组近端左前降支（LAD）和右冠状动脉（RCA）病变患者的完全 STR 比例明显更高（37.5%比 9.7%，p<0.05；59.5%比 30.3%，p<0.05）。两组不良事件发生率相似。