Bedjaoui Ali, Allal Karima, Lounes Mohamed Sofiane, Belhadi Chams Eddine, Mekarnia Abdelmoumen, Sediki Saber, Kara Maamar, Azaza Adel, Monsuez Jean-Jacques, Benkhedda Salim
Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine, Benyoucef Benkhedda University, Algiers, Algeria; Department of Cardiology, Hôpital Central de l'Armée Ain Naadja, Algiers, Algeria.
Department of Cardiology, Hôpital Central de l'Armée Ain Naadja, Algiers, Algeria.
Cardiovasc J Afr. 2019;30(1):45-51. doi: 10.5830/CVJA-2018-063. Epub 2018 Nov 20.
To test whether aspiration thrombectomy with intracoronary (IC) instead of intravenous (IV) administration of abciximab could reduce the no-reflow phenomenon in patients undergoing primary percutaneous intervention (PCI) for ST-elevation myocardial infarction (STEMI).
Despite recanalisation with PCI, failure to restore microvascular flow may affect the prognosis of patients with STEMI. A combination of aspiration thrombectomy with IC abciximab may improve distal perfusion.
After aspiration thrombectomy during primary PCI for STEMI, 160 patients were randomly assigned to either an IV or IC abciximab bolus delivered through the aspiration catheter, both followed by a 12-hour IV abciximab infusion.
ST-segment resolution ≥ 70% was achieved in 36 of 78 patients with IC versus 30 of 82 patients with IV abciximab (46.1 vs 36.6%, p = 0.368), and partial resolution in 28 of 78 versus 31 of 82 patients (35.9 vs 37.8%, p = 0.368). Postprocedural myocardial blush grade (MBG) 3 was obtained in 62.8 vs 63.4% (p = 0.235) and MBG ≥ 2 in 89.7 vs 81.7% (p = 0.148) of patients given IC and IV abciximab, respectively. There were three deaths in each group (3.8%). Major adverse cardiac events occurred in six of 78 patients given the IC and seven of 82 patients given the IV abciximab bolus (7.6 vs 8.5%, p = 0.410). One stroke occurred in each group, and two patients in the IC and nine in the IV group developed renal failure (2.5 vs 10.9%, p = 0.414).
IC versus IV abciximab did not enhance myocardial reperfusion in non-selected patients with STEMI undergoing primary PCI after aspiration thrombectomy had successfully been performed.
测试在接受ST段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入治疗（PCI）的患者中，冠状动脉内（IC）而非静脉内（IV）给予阿昔单抗进行抽吸血栓切除术是否能减少无复流现象。
尽管通过PCI实现了再灌注，但微血管血流未能恢复可能会影响STEMI患者的预后。抽吸血栓切除术与冠状动脉内阿昔单抗联合应用可能会改善远端灌注。
在STEMI直接PCI期间进行抽吸血栓切除术后，160例患者被随机分为两组，分别通过抽吸导管接受静脉或冠状动脉内阿昔单抗推注，随后均进行12小时的静脉阿昔单抗输注。
冠状动脉内给予阿昔单抗的78例患者中有36例（46.1%）ST段回落≥70%，静脉给予阿昔单抗的82例患者中有30例（36.6%）达到该标准（p = 0.368）；冠状动脉内给予阿昔单抗的78例患者中有28例（35.9%）部分回落，静脉给予阿昔单抗的82例患者中有31例（37.8%）达到该标准（p = 0.368）。冠状动脉内和静脉给予阿昔单抗的患者术后心肌 blush分级（MBG）为3级的分别占62.8%和63.4%（p = 0.235），MBG≥2级的分别占89.7%和81.7%（p = 0.148）。每组均有3例死亡（3.8%）。冠状动脉内给予阿昔单抗的78例患者中有6例发生主要不良心脏事件，静脉给予阿昔单抗推注的82例患者中有7例发生（7.6%对8.5%，p = 0.410）。每组均发生1例卒中，冠状动脉内给予阿昔单抗组有2例患者、静脉给予阿昔单抗组有9例患者发生肾衰竭（2.5%对10.9%，p = 0.414）。
在成功进行抽吸血栓切除术后接受直接PCI的非选择性STEMI患者中，冠状动脉内给予阿昔单抗与静脉给予阿昔单抗相比，并未增强心肌再灌注。
