CAJ | 학술논문

目的：探讨校正的心肌梗死溶栓试验（TIMI）帧数（CTFC）评估血栓抽吸在急性ST段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入治疗（PCI）中的临床疗效及短期预后。方法选取行急诊PCI治疗且再灌注成功TIMI血流分级恢复Ⅲ级的STEMI患者75例，根据是否行血栓抽吸分为血栓抽吸＋PCI组（n＝32）和常规PCI组（n＝43）利用CTFC测定梗死相关动脉（IRA）血流，观察两组患者住院期间心功能参数及术后30天内心血管事件发生率。结果血栓抽吸＋PCI组患者左前降支（LAD）及右冠状动脉（RCA）中的CTFC明显少于常规PCI组，差异具有显著性（P＜0.05）；两组患者左回旋支（LCX）中的CTFC比较差异无显著性。两组患者IRA再灌注成功后，在TIMI血流分级Ⅲ级的情况下，血栓抽吸＋PCI组患者术后左室射血分数（LVEF）、肌酸激酶同工酶（CK-MB）峰值时间及30天内心血管事件发生率与常规PCI组比较差异均具有显著性（P＜0.05），其中血栓抽吸＋PCI组患者住院期间发生心源性死亡1例，因心肌梗死后心绞痛发作再次入院1例，常规PCI组患者住院期间发生心源性死亡4例，住院期间发生室性心动过速1例，因心绞痛发作再次入院1例，因严重心力衰竭入院1例，因非靶血管介入入院1例。两组患者住院天数比较差异无显著性。结论 CTFC可有效评价STEMI患者IRA再灌注情况及患者近期预后，有助于对患者进行危险分层和指导治疗。
목적：탐토교정적심기경사용전시험（TIMI）정수（CTFC）평고혈전추흡재급성ST단태고형심기경사（STEMI）급진경피관상동맥개입치료（PCI）중적림상료효급단기예후。방법선취행급진PCI치료차재관주성공TIMI혈류분급회복Ⅲ급적STEMI환자75례，근거시부행혈전추흡분위혈전추흡＋PCI조（n＝32）화상규PCI조（n＝43）이용CTFC측정경사상관동맥（IRA）혈류，관찰량조환자주원기간심공능삼수급술후30천내심혈관사건발생솔。결과혈전추흡＋PCI조환자좌전강지（LAD）급우관상동맥（RCA）중적CTFC명현소우상규PCI조，차이구유현저성（P＜0.05）；량조환자좌회선지（LCX）중적CTFC비교차이무현저성。량조환자IRA재관주성공후，재TIMI혈류분급Ⅲ급적정황하，혈전추흡＋PCI조환자술후좌실사혈분수（LVEF）、기산격매동공매（CK-MB）봉치시간급30천내심혈관사건발생솔여상규PCI조비교차이균구유현저성（P＜0.05），기중혈전추흡＋PCI조환자주원기간발생심원성사망1례，인심기경사후심교통발작재차입원1례，상규PCI조환자주원기간발생심원성사망4례，주원기간발생실성심동과속1례，인심교통발작재차입원1례，인엄중심력쇠갈입원1례，인비파혈관개입입원1례。량조환자주원천수비교차이무현저성。결론 CTFC가유효평개STEMI환자IRA재관주정황급환자근기예후，유조우대환자진행위험분층화지도치료。
Objective To investigate the validity of corrected TIMI frame count (CTFC) in assessing the short-term effect of thrombus suction in the patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Method 75 STEMI patients undcrgoing primary PCI and achieving TIMI-Ⅲgrade lfow were enrolled in this study. They were divided into PCI+thrombus suction group and primary PCI group according to whether to thrombus suction. The patency and flow of infarct-related arteries (IRA) were analyzed by CTFC. Cardiac function during hospitalization and incidence of cardiovascular events within 30 days after primary PCI were also investigated in our study. Result CTFC of LAD and RCA in primary PCI+thrombus suction group were signiifcantly less than that in primary PCI group (P<0.05). There was no obvious difference in CTFC of LCX between the two groups. After successful reperfusion in IRA with TIMI- Ⅲgrade flow, LVEF, peak time of CK-MB and incidence of cardiovascular events within 30 days were significantly different between patients underwent primary PCI together with or without thrombus suction (P < 0.05). In primary PCI + thrombus suction group, 1 case of cardiac arrest occurred during hospitalization and 1 patient was re-hospitalized due to post-infarction angina. In primary PCI group, 4 cases of cardiac arrest and 1 case of ventricular tachycardia occurred during hospitalization, one patient was re-hospitalized due to post-infarction angina, 1 patient was re-hospitalized due to severe heart failure and one patient was re-hospitalized due to interventional therapy for non-IRA. However, the length of hospital stay was similar between the two groups. Conclusion CTFC may be valuable to assess the efifcacy of reperfusion therapy for IRA and the short-term outcome after reperfusion therapy in STEMI. It is also useful to make risk stratiifcation and medical decision in STEMI patients.