CAJ | 학술논문

目的：观察高血栓负荷急性ST段抬高型心肌梗死( STEMI)患者直接经皮冠状动脉介入治疗( PCI)后靶病变的变化及延迟支架置入情况。方法入选48例高血栓负荷STEMI患者,急诊予单纯球囊扩张和(或)冠状动脉血栓抽吸,梗死相关动脉前向血流心肌梗死溶栓试验( TIMI)血流分级3级,7 d后复查冠状动脉造影( CAG),根据靶病变血管狭窄情况必要时置入支架治疗。观察靶病变变化的相关数据,包括狭窄程度、长度、近端参考血管直径、远端参考血管直径,比较老年患者(≥60岁)和中青年患者(﹤60岁)支架置入比例。结果7 d后复查CAG显示靶病变直径狭窄程度较直接PCI时减轻(35.5﹪±14.1﹪比48.8﹪±11.0﹪,P﹤0.01)、病变长度缩短[(15.69±5.36)mm比(18.94±5.37)mm,P﹤0.01],靶病变近端参考血管直径[(3.29±0.33)mm比(3.24±0.32)mm, P=0.02]和远端参考血管直径[(3.18±0.33)mm比(3.08±0.33)mm,P﹤0.01]增大；其中,39.6﹪(19/48)患者因靶病变狭窄＞50﹪置入支架,老年患者和中青年患者置入支架比例分别是56﹪(9/16)、31﹪(10/32)(P=0.04)。结论对于中青年高血栓负荷不适宜直接支架置入术的STEMI患者急诊予单纯球囊扩张和(或)血栓抽吸即时开通梗死相关动脉,再延迟必要时支架置入治疗策略是安全、有效的。
목적：관찰고혈전부하급성ST단태고형심기경사( STEMI)환자직접경피관상동맥개입치료( PCI)후파병변적변화급연지지가치입정황。방법입선48례고혈전부하STEMI환자,급진여단순구낭확장화(혹)관상동맥혈전추흡,경사상관동맥전향혈류심기경사용전시험( TIMI)혈류분급3급,7 d후복사관상동맥조영( CAG),근거파병변혈관협착정황필요시치입지가치료。관찰파병변변화적상관수거,포괄협착정도、장도、근단삼고혈관직경、원단삼고혈관직경,비교노년환자(≥60세)화중청년환자(﹤60세)지가치입비례。결과7 d후복사CAG현시파병변직경협착정도교직접PCI시감경(35.5﹪±14.1﹪비48.8﹪±11.0﹪,P﹤0.01)、병변장도축단[(15.69±5.36)mm비(18.94±5.37)mm,P﹤0.01],파병변근단삼고혈관직경[(3.29±0.33)mm비(3.24±0.32)mm, P=0.02]화원단삼고혈관직경[(3.18±0.33)mm비(3.08±0.33)mm,P﹤0.01]증대；기중,39.6﹪(19/48)환자인파병변협착＞50﹪치입지가,노년환자화중청년환자치입지가비례분별시56﹪(9/16)、31﹪(10/32)(P=0.04)。결론대우중청년고혈전부하불괄의직접지가치입술적STEMI환자급진여단순구낭확장화(혹)혈전추흡즉시개통경사상관동맥,재연지필요시지가치입치료책략시안전、유효적。
Objective To evaluate the changes of target lesions and delayed stent implantation after primary percutaneous coronary intervention ( PCI) in high thrombus burden patients with acute ST elevation myocardial infarction ( STEMI ) . Methods A total of 48 STEMI patients with high thrombus burden underwent primary PCI were enrolled. After treatment of percutaneous transtuminal coronary angioplasty ( PTCA) only and/or catheter aspiration of coronary thrombus, the forward blood flow in infarct-related arteries got thrombolysis in myocardial infarction ( TIMI ) flow grade 3. All patients accepted coronary angiography ( CAG) 7 days after primary PCI and the stenosis of target lesion and delayed stent implantation were evaluated. Data of target lesion changes including degree, length of stenosis, diameter of proximal and distal reference vessel were collected. Stenting proportions were compared between elderly patients (≥60 ys) and young and middle-aged patients ( ﹤60 ys). Results Compared with the data of primary PCI, the stenosis degree alleviated ( 35. 5﹪ ± 14. 1﹪ vs. 48. 8﹪ ± 11. 1﹪, P ﹤0. 01 ) , the length of stenosis shortened [(18. 94 ± 5. 37)mm vs. (15. 69 ± 5. 36)mm, P﹤0. 01], both diameters of proximal [(3. 24 ± 0.32)mmvs. (3.29±0.33) mm,P=0.02] anddistal[(3.08±0.33)mmvs. (3.18±0.33)mm,P﹤0. 01] reference vessel increased when CAG preformed 7 days later. 39. 6﹪(19/48)of the patients received delayed stenting for stenosis>50﹪ in target lesion. 56﹪ (9/16) of the elderly and 31﹪ (10/32) of the young and middle-aged patients (P=0. 04) accepted delayed stent implantation. Conclusions For young and middle-aged STEMI patients with high thrombus burden and unsuitable for primary stenting, the strategy of reperfusing infarct-related artery with primary PTCA and/or catheter aspiration of coronary thrombus, and delayed stenting when necessary is safe and effective.