支架内血栓形成患者行直接经皮冠状动脉介入治疗的结局。
The outcome of primary percutaneous coronary intervention in patients with stent thrombosis.
机构信息
National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
出版信息
Indian Heart J. 2022 Nov-Dec;74(6):464-468. doi: 10.1016/j.ihj.2022.11.003. Epub 2022 Nov 8.
BACKGROUND
Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST.
METHODS
A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed.
RESULTS
Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%.
CONCLUSION
In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI.
背景
直接经皮冠状动脉介入治疗（PCI）是新发 ST 段抬高型心肌梗死（STEMI）患者的推荐治疗策略。然而，直接 PCI 治疗急性、亚急性或晚期支架内血栓形成（ST）引起的 STEMI 的疗效尚不清楚。本研究旨在评估因急性、亚急性或晚期 ST 导致 STEMI 而行直接 PCI 的患者的临床特征和住院结局。
方法
本研究纳入了 100 例因 ST 导致 STEMI 的连续患者。在先前支架植入部位存在血流受限血栓或完全血管闭塞（心肌梗死溶栓治疗（TIMI）血流分级 0 至 II）的血管造影证据被视为 ST。进行直接 PCI，观察所有入组患者和住院期间死亡率。
结果
男性患者 69 例，平均年龄为 58.9±7.78 岁。ST 分为急性 40 例，亚急性 53 例，晚期 7 例。Killip 分级 III/IV 级 45 例。25 例患者出现夹层，74 例患者支架未充分扩张，和/或位置不当 24 例。97 例患者行血栓抽吸术，76 例行普通球囊血管成形术，22 例行支架置入术。32 例患者最终获得 TIMI III 级血流。在平均 4.93±2.46 天的住院期间，死亡率为 27%。
结论
因 ST 导致 STEMI 而行直接 PCI 的患者中，超过 1/4 的患者在住院期间死亡。
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