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目的评价冠状动脉内血栓抽吸导管抽吸血栓联合介入治疗对于改善高龄急性ST段抬高型心肌梗死(STEMI)心肌水灌注的安全性和有效性。方法根据是否应用血栓抽吸导管入选2008年1月至2010年1月在我中心接受急诊冠状动脉介入治疗的年龄≥75岁的198例STE-MI患者分为两组,即血栓抽吸导管组(98例)和对照组(100例)。比较两组临床资料、冠脉造影和介入资料,以及术后心肌生化标记物、左心室射血分数、左心室舒张末内径和随访期间(平均随访12个月)主要心脏不良事件的差异。结果血栓抽吸导管组术后心肌灌注指标及住院期间临床指标(MBG、cTFC、CK-MB、无或慢血流比例)均显示优于对照组(P<0.05);左心室射血分数、左心室舒张末径两组比较未显示统计学差异。随访平均时间(13.1±5.8)个月,抽吸导管组心源性死亡率、心脏原因再次住院率显著低于对照组(P<0.05),再发心肌梗死、靶血管再次血运重建、再发心绞痛等主要心脏不良事件少于对照组,但无显著差异(P>0.05)。结论抽吸导管可进一步改善STEMI介入治疗后的心肌组织灌注,减少心源性死亡等主要心血管病事件的发生。
Objective To evaluate the safety and efficacy of combined intra-coronary thrombus aspiration catheterization and thrombectomy for improving myocardial perfusion in elderly patients with acute ST-segment elevation myocardial infarction (STEMI). Methods 198 patients with STE-MI ≥75 years of age undergoing primary PCI undergoing PCI at our center from January 2008 to January 2010 were divided into two groups according to whether thrombus aspiration catheter was used or not: thrombus aspiration catheter group (98 cases) and control group (100 cases). The clinical data, coronary angiography and interventional data were compared between the two groups. The postoperative myocardial biochemical markers, left ventricular ejection fraction, left ventricular end-diastolic diameter, and the difference in major adverse cardiac events during follow-up (mean follow-up of 12 months) were compared. Results The postoperative myocardial perfusion parameters and clinical parameters (MBG, cTFC, CK-MB, no or slow blood flow ratio) in the thrombus aspiration catheter group were significantly better than those in the control group (P <0.05). The left ventricular ejection fraction, Left ventricular diastolic diameter did not show statistical difference between the two groups. The mean follow-up time was (13.1 ± 5.8) months. The rate of cardiac death and cardiopulmonary resuscitation in the aspiration catheter group was significantly lower than that in the control group (P <0.05), and myocardial infarction and target revascularization were performed again Angina and other major adverse cardiac events than the control group, but no significant difference (P> 0.05). Conclusion Aspiration catheter can further improve myocardial perfusion after STEMI intervention and reduce the incidence of major cardiovascular events such as cardiac death.