何晴,董淑娟,李静超,余海佳,宋慧慧,崔路乾,楚英杰

• 1:河南省人民医院心内科

摘要(Abstract)：

目的 运用光学相干断层成像（OCT）探讨非ST段抬高型心肌梗死（NSTEMI患者的梗死相关血管（IRA）闭塞状态与血栓类型的关系。方法 回顾性研究2021年10月至2023年8月于河南省人民医院行急诊冠状动脉介入治疗且术中使用OCT检查的NSTEMI患者170例，其中IRA完全闭塞组83例，IRA非完全闭塞组87例，结合患者基线特征、造影结果及OCT结果进行比较分析。结果 与IRA非完全闭塞组相比，IRA完全闭塞组的患者更年轻（P=0.013），男性比例更高（P=0.026），而患高血压病（P=0.010）和糖尿病（P=0.033）的比例较低。冠状动脉造影结果表明，IRA完全闭塞组IRA多见于左回旋支，而IRA非完全闭塞组多见于左前降支（P=0.012）;IRA完全闭塞组侧支循环分级Ⅱ～Ⅲ级的比例高于IRA非完全闭塞组（P=0.022）。OCT结果显示，IRA完全闭塞组多数情况下由斑块破裂事件引起（P=0.014），主要以红色/混合血栓为主（P<0.001）；而IRA非完全闭塞组则更常见于斑块侵蚀事件（P=0.014），以白色血栓为主（P<0.001）。结论 NSTEMI患者IRA完全闭塞常发于左回旋支，且患者更年轻，血栓类型以红色/混合血栓为主，而IRA非完全闭塞病变以白色血栓为主。

关键词(KeyWords)： 非ST段抬高型心肌梗死;光学相干断层成像;梗死相关血管;血栓类型

Abstract:

Keywords:

基金项目(Foundation): 河南省医学科技攻关计划联合共建项目（LHGJ20220001）

作者(Author): 何晴,董淑娟,李静超,余海佳,宋慧慧,崔路乾,楚英杰

参考文献(References)：

• [1] Bassand JP,Hamm CW,Ardissino D,et al.Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes[J].Eur Heart J,2007,28(13):1598-1660.DOI:10.10 9 3/eurheartj/ehm161.
• [2]Hamm CW,Bassand JP,Agewall S,et al.ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:the task forcefor the management of acute coronary syndromes(ACS)in patients presenting without persistent ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2011,32(23):2999-3054.DOI:10.1093/eurheartj/ehr236.
• [3]Hung CS,Chen YH,Huang CC,et al.Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded"culprit"artery-a systemic review and meta-analysis[J].Crit Care,2018,22(1):34.DOI:10.1186/s13054-018-1944-x.
• [4]Khan AR,Golwala H,Tripathi A,et al.Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction:a systematic review and meta-analysis[J].Eur Heart J,2017,38(41):3082-3089.DOI:10.1093/eurheartj/ehx418.
• [5]Ino Y,Kubo T,Tanaka A,et al.Difference of culprit lesion morphologies between ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome:an optical coherence tomography study[J].JACC Cardiovasc Interv,2011,4(1):76-82.DOI:10.1016/j.jcin.2010.09.022.
• [6]Porto I,Mattes ini A,Valente S,et al.Optical coherence tomography assessment and quantification of intracoronary thrombus:status and perspectives[J].Cardiovasc Revasc Med,2015,16(3):172-178.DOI:10,1016/j.carrev.2015.01.007.
• [7]Dallan LAP,Gabasha S,Osman MN,et al.Optical coherence tomography-guided assessment for spontaneous coronary artery dissection in NSTEMI:OCT as a game changer[J].Int J Cardiovasc Imaging,2023,39(2):269-271.DOI:10.1007/s10554-022-02720-x.
• [8]Collet JP,Thiele H,Barbato E,et al.2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation[J].Eur Heart J,2021,42(14):1289-1367.DOI:10.1093/eurheartj/ehaa575.
• [9]Ganz W.The thrombolysis in myocardial infarction(TIMI)trial[J].N Engl J Med,1985,313(16):1018.DOI:10.1056/NEJM198510173131611.
• [10]王正龙,张巍,许娟,等.急性STEMI与NSTEMI患者冠状动脉闭塞比较[J].中国老年学杂志,2022,42(10):2305-2309.DOI:10.3969/j.issn.1005-9202.2022.10.001.
• [11]Dixon WC 4th,Wang TY,Dai D,et al.Anatomic distribution of the culprit lesion in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention:findings from the National Cardiovascular Data Registry[J],J Am Coll Cardiol,2008,52(16):1347-1348.DOI:10.1016/j.jacc.2008.07.029.
• [12]Grenne B,Eek C,Sj?li B,et al.Acute coronary occlusion in non-ST-elevation acute coronary syndrome:outcome and early identification by strain echocardiography[J],Heart,2010,96(19):1550-1556.DOI:10.1136/hrt.2009.188391.
• [13]Karwowski J,Polonski L,Gierlotka M,et al.Total coronary occlusion of infarct-related arteries in patients with non-STelevation myocardial infarction undergoing percutaneous coronary revascularisation[J].Kardiol Pol,2017,75(2):108-116.DOI:10.5603/KP.a2016.013 0.
• [14]Fefer P,Knudtson ML,Cheema AN,et al.Current perspectives on coronary chronic total occlusions:the Canadian multicenter chronic total occlusions registry[J].J Am Coll Cardiol,2012;59(11):991-997.DOI:10.1016/j.jacc.2011.12.007.
• [15]Pride YB,Tung P,Mohanavelu S,et al.Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depression:a TRITON-TIMI 3 8(Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel.Thrombolysis In Myocardial Infarction 38)sub study[J].JACC Cardiovasc Interv,2010,3(8):806-811.DOI:10.1016/j.jcin.2010.05.012.
• [16] Moustafa A,Abi-Saleh B,El-Baba M,et al.Anatomic distribution of culprit lesions in patients with non-ST-segment elevation myocardial infarction and normal ECG[J].Cardiovasc Diagn Ther,2016,6(1):25-33.DOI:10.3978/j.issn.2223-3652.2015.10.05.
• [17]董淑娟,杨亚攀,楚英杰,等.急性心肌梗死患者冠脉造影和血栓类型分析[J].中华急诊医学杂志,2020,29(10):1337-1342.DOI:10.3760/cma.j.issn.1671-0282.2020.10.012.
• [18] Quadros AS,Cambruzzi E,Sebben J,et al.Red versus white thrombi in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention:clinical and angiographic outcomes[J].Am Heart J,2012,164(4):553-560.DOI:10.1016/j.ahj.2012.07.022.
• [19]Mizuno K,Satomura K,Miyamoto A,et al.Angioscopic evaluation of coronary-artery thrombi in acute coronary syndromes[J].N Engl J Med,1992,326(5):287-291.DOI:10.1056/NEJM199201303260502.
• [20]刘耀琨,郑博,霍勇.冠心病领域临床研究2023年度进展[J].中国介入心脏病学杂志,2024,32(1):24-31.DOI:10.3969/j.issn.1004-8812.2024.01.006.
• [21]宋慧慧,楚英杰,董淑娟,等.光学相干断层成像技术对STEMI患者冠脉内血栓类型的研究[J].实用医学杂志,2019,35(4):611-614.DOI:10.3969/j.issn.1006-5725.2019.04.023.
• [22]Vlaar PJ,Diercks GF,Svilaas T,et al.The feasibility and safety of routine thrombus aspiration in patients with nonST-elevation myocardial infarction[J].Catheter Cardiovasc Interv,2008,72(7):937-942.DOI:10.1002/ccd.21717.
• [23] Cetin MS,Ozcan Cetin EH,Baler KG,et al.The association between whole blood viscosity and coronary collateral circulation in patients with chronic total occlusion[J].Korean Circ J,2016,46(6):784-790.DOI:10.4070/kcj.2016.46.6.784.
• [24]唐胜惠.血栓抽吸导管内注入硝普钠对经皮冠状动脉介入后无复流现象的影响[J].广西医学,2017,39(1):69-71.DOI:10.11675/j.issn.025 3-4304.2017.01.20.
• [25]程静,李金萍.血栓抽吸术在急性心肌梗死PCI术中重要性的临床研究[J].中西医结合心血管病电子杂志,2017,5(1):49,52.DOI:10.3969/j.issn.2095-6681.2017.01.034.
• [26]郝伟,赵晨,胡思宁,等.急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术后无复流现象的最新研究进展[J].中国介入心脏病学杂志,2023,31(5):380-386.DOI:10.3969/j.issn.1004-8812.2023.05.010.
• [27]Thiele H,de Waha S,Zeymer U,et al.Effect of aspiration thrombectomy on microvascular obstruction in NSTEMI patients:the TATORT-NSTEMI trial[J].J Am Coll Cardiol,2014,64(11):1117-1124.DOI:10.1016/j.jacc.2014.05.064.
• [28] Meyer-Saraei R,de Waha S,Eitel I,et al.Thrombus aspiration in non-ST-elevation myocardial infarction-12-month clinical outcome of the randomised TATORT-NSTEMI trial[J].Eur Heart J Acute Cardiovasc Care,2017,6(1):10-17.DOI:10.1177/2048872615617044.