唐良秋,张晓静,陈云宪,徐新,马绍椿,陈宝峰,陈锦峰,梁家荣,孙维倩,刘相应

• 1:粤北人民医院心血管内科
• 2:乐昌市第二人民医院心血管内科

摘要(Abstract)：

目的比较经抽吸导管超选择至罪犯血管病变闭塞处前注射替罗非班后行血栓抽吸治疗与经指引导管于罪犯血管开口处注射替罗非班后行血栓抽吸治疗对急性ST段抬高心肌梗死(STEMI)患者预后的影响。方法连续入选靶血管肉眼可见(两位手术医师同时判断)血栓负荷的STEMI患者112例,随机分为两组:A组56例,经指引导管于罪犯冠状动脉开口注射替罗非班再行血栓抽吸术;B组56例,经抽吸导管于罪犯冠状动脉闭塞处前注射替罗非班再行血栓抽吸术。A组又分A1组26例、A2组30例,B组又分B1组31例、B2组25例,A1、B1指罪犯血管为左前降支或回旋支,A2、B2指罪犯血管为右冠状动脉且为分叉前闭塞。比较各组患者血栓抽吸后TIMI血流分级、住院期间出血情况及术后12个月主要不良心血管事件(MACE)的发生情况。结果 A1组和B1组、A2组和B2组的病变血管支数和罪犯血管分布情况分别比较,差异均无统计学意义(均P>0.05)。B1组行血栓抽吸1 min后[19例(73.1%)比27例(87.1%),P=0.04]和支架释放后即刻[22例(84.6%)比30例(96.8%),P<0.01]罪犯血管TIMI血流分级Ⅲ级占比高于A1组。A2组和B2组给药前、血栓抽吸1 min后、支架释放后即刻TIMI血流分级比较,差异均无统计学意义(均P>0.05)。A组和B组患者住院期间均未发生严重出血事件,中度出血和轻微出血的发生率分别比较,差异均无统计学意义(均P>0.05)。A1组住院期间[4例(15.4%)比2例(6.5%),P=0.03]及术后3个月[3例(11.5%)比1例(3.2%),P<0.01]的MACE发生率高于B1组,而术后12个月MACE发生率的差异无统计学意义。A2组和B2组住院期间、术后3个月及术后12个月的MACE发生率比较,差异均无统计学意义。结论对于病变血管为左冠状动脉的患者,经血栓抽吸导管超选择至病变闭塞处前给药对预防慢血流/无复流及减少患者短期(3个月内)MACE发生率效果可能会更好,而对于病变血管为右冠状动脉且为分叉前闭塞的患者,经血栓抽吸导管或经指引导管给药,效果可能无明显差异。

关键词(KeyWords)： 急性ST段抬高心肌梗死;替罗非班;血栓抽吸导管;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 唐良秋,张晓静,陈云宪,徐新,马绍椿,陈宝峰,陈锦峰,梁家荣,孙维倩,刘相应

参考文献(References)：

• [1]Kopetz VA,Penno MA,Hoffmann P,et al.Potential mechanisms of the acute coronary syndrome presentation in patients with the coronary slow flow phenomenon-insight from a plasma proteomic approach.Int J Cardiol,2012,156:84-91.
• [2]Burzotta F,Trani C,Romagnoli E,et al.A pilot study with a new,rapid-exchange,thrombus-aspirating device in patients with thrombus-containing lesions:the Diver C.E.study.Catheter Cardiovasc Interv,2006,67:887-893.
• [3]De Luca G,Ucci G,Cassetti E,et al.Benefits from small molecule administration as compared with abciximab among patients with ST-segment elevation myocardial infarction treated with primary angioplasty:a meta-analysis.J Am Coll Cardiol,2009,53:1668-1673.
• [4]De Luca G,Verdoia M,Suryapranata H.Benefits from intracoronary as compared to intravenous abciximab administration for STEMI patients undergoing primary angioplasty:a metaanalysis of 8 randomized trials.Atherosclerosis,2012,222:426-433.
• [5]张立博.血栓抽吸前后冠状动脉内注射替罗非班在急性ST段抬高型心肌梗死患者中的应用.中国介入心脏病学杂志,2012,20:38-42.
• [6]中华医学会心血管病分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2015,43:380-393.
• [7]The GUSTO investigators.An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.N Engl J Med,1993,329:673-682.
• [8]Pu J,Mintz GS,Biro S,et al.Insights into echo-attenuated plaques,echolucent plaques,and plaques with spotty calcification:novel findings from comparisons among intravascular ultrasound,near-infrared spectroscopy,and pathological histology in 2,294 human coronary artery segments.J Am Coll Cardiol,2014,63:2220-2233.
• [9]秦华,梁先明.新型血小板GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班.中国新药杂志,2002,11:197.
• [10]Hara M,Saikawa T,Tsunematsu Y,et al.Predicting no-reflow based on angiographic features of lesions in patients with acute myocardial infarction.J Atheroscler Thromb,2005,12:315-321.
• [11]American College of Emergency Physicians,Society for Cardiovascular Angiography and Interventions,O'Gara PT,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines..J Am Coll Cardiol,2013,61:e78-e140.
• [12]Candemir B,Kilickap M,Ozcan OU,et al.Intracoronary versus intravenous high-dose bolus plusm aintenance administration of tirofiban in patients undergoing primary percutaneous coronary intervention for acute ST elevation myocardial infarction.J Thromb Thrombolysis,2012,34:65-72.
• [13]张大鹏,王乐丰,杜锦权,等.经血栓抽吸导管注射替罗非班和硝普钠对重度血栓负荷前壁急性心肌梗死患者急诊介入治疗效果的影响.中华心血管病杂志,2014,42:25-30.
• [14]Vlaar PJ,Svilaas T,van der Horst IC,et al.Cardiac death and reinfarction after 1 year in the thrombus aspiration during pereutaneous coronary intervention in acute myocardial infarction study(TAPAS):a 1-year follow up study.Lancet,2008,371:19l5-1920.
• [15]娄唯鸣.血栓抽吸前替罗非班冠状动脉内注射在急性ST段抬高型心肌梗死患者中的应用.郑州大学学报(医学版),2012,47:870-873.