Turgeman Yoav, Bushari Limor Ilan, Antonelli Dante, Feldman Alexander, Yahalom Malka, Bloch Lev, Suleiman Khalid
Heart Institute, H'aEmek Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Int J Angiol. 2014 Mar;23(1):29-40. doi: 10.1055/s-0033-1358782.
We assess the epicardial and microcirculation flow characteristics, and clinical outcome by using catheter aspiration after each stage of primary percutaneous coronary intervention (PPCI). Conflicting data are reported regarding early and late benefit of using aspiration catheter in the initial phase PPCI. A total of 100 patients with ST-segment elevation acute myocardial infarction (STEMI) were included: 51 underwent PPCI without using an aspiration device (SA group) and 49 underwent PPCI by activating an aspiration catheter after each stage of procedure; wiring, ballooning and stenting, respectively (MA group). Thrombolysis in myocardial infarction (TIMI) flow grade, TIMI frame counts and myocardial blush grade (MBG) were evaluated in each group during every stage of procedure. Major adverse cardiac events were evaluated in the index hospitalization and during 30 and 180 days of follow-up. A TIMI flow grade 2-3 was more prevalent in the MA group compared with the SA group only after wiring: 65.9 versus 39.1% (p = 0.01), but TIMI frame counts were lower in the MA versus SA group throughout all procedural steps. MBG 2-3 was statistically higher in the MA group compared with the SA group mainly after wiring. After stenting there were no significant changes in both epicardial and microcirculation flow parameters. There were no significant differences between the groups in early and late clinical outcomes. Improved flow parameters were noticed in the MA group only by activating the aspiration device after wiring. This early advantage disappeared after stenting. The initial better flow characteristic in the MA group was not translated into a better early or late clinical outcome.
我们通过在直接经皮冠状动脉介入治疗（PPCI）的每个阶段使用导管抽吸来评估心外膜和微循环血流特征以及临床结局。关于在PPCI初始阶段使用抽吸导管的早期和晚期益处，有相互矛盾的数据报道。共纳入100例ST段抬高型急性心肌梗死（STEMI）患者：51例未使用抽吸装置进行PPCI（SA组），49例在手术的每个阶段（分别为导丝置入、球囊扩张和支架置入）后通过启动抽吸导管进行PPCI（MA组）。在手术的每个阶段对每组的心肌梗死溶栓（TIMI）血流分级、TIMI帧计数和心肌 blush分级（MBG）进行评估。在住院期间以及随访的30天和180天对主要不良心脏事件进行评估。仅在导丝置入后，MA组的TIMI血流2 - 3级比SA组更常见：65.9%对39.1%（p = 0.01），但在所有手术步骤中MA组的TIMI帧计数均低于SA组。主要在导丝置入后，MA组的MBG 2 - 3级在统计学上高于SA组。支架置入后，心外膜和微循环血流参数均无显著变化。两组在早期和晚期临床结局方面无显著差异。仅在导丝置入后通过启动抽吸装置，MA组的血流参数得到改善。这种早期优势在支架置入后消失。MA组最初较好的血流特征并未转化为更好的早期或晚期临床结局。
