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中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (09) : 674 -679. doi: 10.3877/cma.j.issn.1674-0785.2020.09.002

所属专题: 文献

临床研究

直接支架植入在血栓高负荷急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗中的临床疗效
阿拉腾宝力德1, 李淑娟1,()   
  1. 1. 010010 呼和浩特,内蒙古医科大学附属医院急诊内科
  • 收稿日期:2020-04-01 出版日期:2020-09-15
  • 通信作者: 李淑娟

Clinical efficacy of direct stenting during primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction with high thrombus burden

Alatengbaolide1, Shujuan Li1,()   

  1. 1. Department of Emergency Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, China
  • Received:2020-04-01 Published:2020-09-15
  • Corresponding author: Shujuan Li
  • About author:
    Corresponding author: Li Shujuan, Email:
引用本文:

阿拉腾宝力德, 李淑娟. 直接支架植入在血栓高负荷急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗中的临床疗效[J]. 中华临床医师杂志(电子版), 2020, 14(09): 674-679.

Alatengbaolide, Shujuan Li. Clinical efficacy of direct stenting during primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction with high thrombus burden[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(09): 674-679.

目的

评价直接支架植入在血栓高负荷ST段抬高型急性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中的临床应用疗效。

方法

回顾性分析内蒙古医科大学附属医院急诊内科2016年3月至2018年2月行PCI治疗的298例血栓高负荷STEMI患者临床资料,根据植入支架前对靶病变处理方式不同,将其分为2组,即球囊预扩张+PCI组(对照组,49例)和未行球囊预扩张直接PCI组(试验组,249例),采用χ2检验比较2组患者PCI术后无回流发生率、术后2 h内相关梗死动脉ST段回落率及主要心血管不良事件(MACE)发生率的差异。将单因素分析差异具有统计学意义的因素纳入Logistic回归分析,分析发生无回流的危险因素。

结果

2组患者PCI术后发生无回流者31例(10.4%,31/298),其中试验组为3例(1.2%,3/249),低于对照组的28例(57.1%,28/49),差异具有统计学意义(χ2=137.453,P<0.001);试验组术后2 h内相关梗死动脉ST段回落<50%者2例(0.8%,2/249),对照组为18例(36.7%,18/49),组间差异具有统计学意义(χ2=162.213,P<0.001);术后30 d内试验组发生急性心力衰竭者21例(8.4%,21/249),冠心病死亡8例(16.3%,8/49),对照组发生急性心力衰竭者18例(36.7%,18/49),冠心病死亡0例,组间差异均有统计学意义(χ2=28.830,42.216,P均<0.001)。Logistic回归分析显示球囊预扩张是无回流发生的危险因素(OR=47.594,P<0.001)。

结论

血栓高负荷STEMI患者行PCI时,术中尽量减少对靶病变球囊预扩张处理,直接植入支架,可有效减少术后无回流的发生,从而降低术后30 d内MACE的发生。

Objective

To evaluate the clinical efficacy of direct stenting during primary percutaneous coronary intervention (PCI) for patients with acute ST-segment elevation myocardial infarction (STEMI) with high thrombus burden.

Methods

We retrospective analyzed the clinical data of 298 patients with STEMI with high thrombus burden treated by PCI at the Department of Emergency Medicine of the Affiliated Hospital of Inner Mongolia Medical University between March 2016 and February 2018. The patients were divided into two groups according to different treatment methods for target lesions before stent implantation, namely, balloon predilation+ PCI group (control group) and direct PCI without balloon predilation group (experimental group). The chi-square test was used to compare the incidence of no-reflow phenomenon (NR) and rates of ST-segment resolution and major adverse cardiac events (MACE) between the two groups. Factors with a statistically significant difference in univariate analysis were included into Logistic regression analysis to identify the independent risk factors for NR.

Results

There were 31 (10.4%, 31/298) patients with no reflow after PCI in the two groups, including 3 (1.2%, 3/249) in the experimental group and 28 (57.1%, 28/49) in the control group; there was a statistically significant difference between the two groups (χ2=137.453, P<0.001). For patients with a ST-segment elevation drop rate< 50% in the infarcted artery within 2 h after surgery, there were 2 (0.8%, 2/249) cases in the experimental group, and 18 (36.7%, 18/49) cases in the control group; there was a statistically significant difference between them (χ2=162.213, P<0.001). The rates of acute heart failure within 30 days after surgery [18 (36.7%) vs 21 (8.4%, 21/249, χ2=28.830, P<0.001] and cardiac death after primary PCI [8 (16.3%, 8/49) vs 0 (0%, 0/49), χ2=42.216, P<0.001] were significantly higher in the control group than in the experimental group. Logistic regression analysis demonstrated that balloon predilation was positively correlated with NR (odds ratio=47.594, P<0.001).

Conclusion

Direct stenting without balloon predilation can effectively reduce the incidence of NR and MACE and decrease mortality when performing primary PCI for patients with high thrombus burden STEMI.

表1 2组血栓高负荷STEMI患者临床基线资料对比
类别 对照组(49例) 试验组(249例) 统计值 P 类别 对照组(49例) 试验组(249例) 统计值 P
年龄(岁) 68.9±10.87 58.0±13.4 t=4.353 <0.001   <60 19(38.8) 132(53.0)    
性别[例(%)]     χ2=0.001 1.000   60~90 18(36.7) 90(36.1)    
  28(57.1) 142(57.0)       >90 12(24.5) 27(10.8)    
  21(42.9) 107(43.0)     靶病变血管[例(%)]     χ2=5.834 0.054
高血压[例(%)]     χ2=0.209 0.748   左前降支 33(67.3) 149(59.8)    
  17(34.7) 95(38.2)       右冠状动脉 15(30.6) 64(25.7)    
  32(65.3) 154(61.8)       回旋支 1(2.0) 36(14.5)    
糖尿病[例(%)]     χ2=0.029 1.000 射血分数<40%[例(%)]     χ2=22.228 <0.001
  21(42.9) 139(55.8)       20(40.8) 32(12.9)    
  28(57.1) 110(44.2)       29(59.2) 217(87.1)    
高脂血症[例(%)]     χ2=3.005 0.110 Killip分级[例(%)]     χ2=75.065 <0.001
  25(51.0) 94(37.8)       Ⅰ级 2(4.1) 70(28.1)    
  24(49.0) 155(62.2)       Ⅱ级 29(59.2) 150(60.2)    
吸烟[例(%)]     χ2=0.449 0.532   Ⅲ级 2(4.1) 26(10.4)    
  25(51.0) 140(56.2)       Ⅳ级 16(32.7) 3(1.2)    
  24(49.0) 109(43.8)     IABP[例(%)]     χ2=67.632 <0.001
肥胖[例(%)]     χ2=0.008 1.000   15(30.6) 2(0.8)    
  21(42.9) 105(42.2)       34(69.4) 247(99.2)    
  28(57.1) 144(57.8)     无回流现象[例(%)]     χ2=137.453 <0.001
发病时间[h,例(%)]     χ2=9.101 0.028   28(57.1) 3(1.2)    
  <3 15(30.6) 107(43.0)       21(42.9) 246(98.8)    
  3~6 22(44.9) 70(28.1)     预后[例(%)]     χ2=42.216 <0.001
  6~12 4(8.2) 46(18.5)       生存 41(83.7) 246(98.8)    
  12~24 8(16.3) 26(10.4)       死亡 8(16.3) 0    
D-to-B时间[min,例(%)]     χ2=7.468 0.024   失访 0 3(1.2)    
表2 2组血栓高负荷STEMI患者PCI术后心肌梗死溶栓治疗血流分级[例(%)]
表3 2组血栓高负荷STEMI患者PCI术后MACE发生对比[例(%)]
表4 无回流的预测因素的Logistic回归分析
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