延迟支架置入术在老年ST段抬高型心肌梗死伴高血栓负荷患者中的疗效和安全性
Efficacy and Safety of Deferred Stenting in Geriatric Patients with STEMI and High Thrombus Burden.
作者信息
Liu Ruifang, Xu Fangxing, Liu Tongku, Zhou Yujie, Wu Xiaofan
机构信息
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, 100029 Beijing, China.
The Center of Cardiology, Affiliated Hospital of Beihua University, 132011 Jilin, Jilin, China.
出版信息
Rev Cardiovasc Med. 2024 Mar 5;25(3):88. doi: 10.31083/j.rcm2503088. eCollection 2024 Mar.
BACKGROUND
Deferred stenting has been recognized as beneficial for patients with acute ST-segment elevation myocardial infarction (STEMI) accompanied by a high thrombus burden. Nevertheless, its efficacy and safety specifically in geriatric STEMI patients remain to be elucidated. This study aims to bridge this knowledge gap and assess the potential advantages of deferred stenting in an older patient cohort.
METHODS
In this study, 208 geriatric patients (aged 80 years) with STEMI and a high thrombus burden in the infarct-related artery (IRA) were enrolled. They were categorized into two groups: the deferred stenting group, where stent implantation was conducted after 7-8 days of continuous antithrombotic therapy, and the immediate stenting group, where stent implantation was performed immediately.
RESULTS
In the deferred stenting group, the stents used were significantly larger in diameter and shorter in length compared to those in the immediate stenting group ( 0.05). This group also exhibited a lower incidence of distal embolism in the IRA, and higher rates of the thrombolysis in myocardial infarction (TIMI) blood flow grade 3 and myocardial blush grade 3 ( 0.05). Additionally, the left ventricular ejection fractions at the 1-year follow-up were significantly higher in the deferred stenting group than in the immediate stenting group ( 0.05). The rate of the major adverse cardiac events in the deferred stenting group was significantly lower than in the immediate stenting groups ( 0.05).
CONCLUSIONS
Deferred stenting for geriatric patients with STEMI and high thrombus burden demonstrates significant clinical benefits. This approach not only reduces the incidence of distal embolism in the IRA, but also enhances myocardial tissue perfusion and preserves cardiac ejection function. Moreover, deferred stenting has proven to be safe in this patient population, indicating its potential as a preferred treatment strategy in such cases.
背景
延迟支架置入术已被认为对伴有高血栓负荷的急性ST段抬高型心肌梗死（STEMI）患者有益。然而，其在老年STEMI患者中的疗效和安全性仍有待阐明。本研究旨在填补这一知识空白，并评估延迟支架置入术在老年患者队列中的潜在优势。
方法
本研究纳入了208例年龄≥80岁、梗死相关动脉（IRA）血栓负荷高的STEMI老年患者。他们被分为两组：延迟支架置入组，在连续抗栓治疗7 - 8天后进行支架植入；即刻支架置入组，立即进行支架植入。
结果
与即刻支架置入组相比，延迟支架置入组使用的支架直径明显更大，长度更短（P < 0.05）。该组IRA远端栓塞的发生率也较低，心肌梗死溶栓（TIMI）血流3级和心肌 blush分级3级的比例更高（P < 0.05）。此外，延迟支架置入组1年随访时的左心室射血分数明显高于即刻支架置入组（P < 0.05）。延迟支架置入组的主要不良心脏事件发生率明显低于即刻支架置入组（P < 0.05）。
结论
对于血栓负荷高的老年STEMI患者，延迟支架置入术具有显著的临床益处。这种方法不仅降低了IRA远端栓塞的发生率，还增强了心肌组织灌注并保留了心脏射血功能。此外，延迟支架置入术在该患者群体中已被证明是安全的，表明其在此类病例中作为首选治疗策略的潜力。
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