直接支架置入与预扩张后支架置入处理急性心肌梗死相关病变的对比研究Comparison of coronary stenting with or without predilation for infarct related lesions in patients with acute myocardial infarction
李成祥,贾国良,郭文怡,李伟杰,栾荣华,王琼,吕安林
摘要(Abstract)：
目的 探讨直接支架置入术处理急性心肌梗死相关病变 (IRL)的安全性、可行性 ,以及扩张压对无复流 慢血流发生率的影响。方法 发病 4 8h内行介入治疗的首次急性心肌梗死患者 ,在导丝通过后IRL开通 ,弥漫性或巨大血栓形成、明显钙化、长度≥ 2 0mm的病变除外。比较球囊预扩张组 (A组 )、直接支架组 (B组 )的成功率和严重并发症发生率。比较最大扩张压≤ 12 16kPa(12atm ,1atm =10 1 32 5kPa) ,与 >12 16kPa患者支架置入后即刻无复流 慢血流的发生率。结果 A组 35例 ,B组 4 2例 ,A、B组的成功率分别为 10 0 %和 95 % ,B组 2例 (5 % )因IRL成角 ,支架无法直接通过 ,球囊预扩张后均成功置入原支架。两组无 1例发生介入治疗相关的严重心脏事件 (死亡、再梗死、急诊冠状动脉旁路移植术 )。最大扩张压≤ 12 16kPa和 >12 16kPa患者支架置入后即刻无复流 慢血流的发生率分别为 7%和 32 % (P <0 0 5 )。结论 直接置入支架术处理IRL ,安全可行 ,成功率高 ;高压扩张置入支架后即刻无复流 慢血流发生率高。
关键词(KeyWords)： 急性心肌梗死;支架;冠状动脉成形术,经皮,经腔;无复流
基金项目(Foundation):
作者(Author): 李成祥,贾国良,郭文怡,李伟杰,栾荣华,王琼,吕安林
参考文献(References)：
- 1KovarLI,MonradES ,ShermanW ,etal.Arandomizedtrialofstentingwithorwithoutballoonpredilationforthetreatmentofcoronaryarterydisease.AmHeartJ,2001,142:E9.
- 2TimurkayanakT ,OzdemirM ,CengelA ,etal.Directstentinginangiographicallyapparentthrombus containinglesions.JInvasiveCardiol,2001,13:742747.
- 3AntoniucciD ,ValentiR ,MiglioriniA ,etal.Directinfarctarterystentingwithoutpredilationandno reflowinpatientswithacutemyocardialinfarction.AmheartJ,2001,142:684690.
- 4HerzI,AssaliA ,SolodkyA ,etal.Coronarystentdeploymentwithoutpredilationinacutemyocardialinfarction:afeasible,safe,andeffectivetechnique.Angiology,1999,50:901908.
- 5HamonM ,RichardeauY ,LecluseE ,etal.Directcoronarystentingwithoutballoonpredilationinacutecoronarysyndromes.AmheartJ ,1999,138(1Pt1):5559.
- 6PizzettiG ,BelottiG ,MargonatoA ,etal.Coronaryrecanalizationbyelectiveangioplastypreventsventriculardilationafteranteriormyocardialinfarction.JAmCollCardiol,1996,28:837845.
- 7GreshED ,SuttonAGC ,CampbellPG ,etal.Reappraisingtheroleofimmediateinterventionfollowingthombolyticrecanalizationinacutemyocardialinfarction.AmJCardiol,2000,86:400405.
- 8SchweigerMJ,CannonCP ,MurphySA ,etal.Earlycoronaryinterventionfollowingpharmacologictherapyforacutemyocardialinfarction(thecombinedTIMI10B TIMI14experince).AmJCardiol,2001,88:831836.
- 9LoubeyreC ,MoriceMC ,LefevreT ,etal.Arandomizedcomparisonofdirectstentingwithconventionalstentimplantationinselectedpatientswithacutemyocardialinfarction.JAmCollCardiol,2002,39:1521.
- 10SabatierR ,HamonM ,ZhaoQM ,etal.Coulddirectstentingreduceno reflowinacutecoronarysyndromes?Arandomizedpilotstudy.AmHeartJ,2002,143:10271032.