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目的 评价STEMI急诊PCI中应用AngioguardTMDPD的疗效和安全性。方法 自 2 0 0 2年 7月至 12月 ,共 4 0例接受急诊PCI治疗的STEMI患者纳入研究 ,其中AngioguardTMDPD组 2 1例 ,对照组 19例。比较两组间的基础临床状况、造影情况、介入治疗结果以及住院期间随访情况 ,病变血管术后均行TIMI分级、TIMI计帧和心肌Blush分级。结果 AngioguardTM DPD组中 ,19例获得成功(90 4 % ) ,网篮内均有多少不等的血栓样物质。两组间的基础临床状况、术前造影情况和术后TIMI3级 (10 0 %和 84 % ,P =0 2 3)差异均无显著性。但DPD组与对照组间发生远端小血管栓塞为 (5 2 %和36 8% ,P =0 0 4 2 ) ;两组的TIMI帧数为 (19 9± 5 7和 30 3± 9 6 ,P <0 0 0 1) ;Blush 3级获得率为(73 7%和 31 6 % ,P =0 0 2 2 )。DPD组术后CK峰值浓度较低 ,ST段回落幅度大 ,近期左室射血分数高 ,均优于对照组 (P <0 0 5 )。两组住院期间均无主要心血管事件发生。结论 在某些STEMI病人中 ,急诊PCI时应用AngioguardTM DPD安全可行 ,可改善患者术后的远端心肌血流灌注 ,提高患者的心功能。应用TIMI计帧法和Blush分级法优于应用TIMI分级法。
Objective To evaluate the efficacy and safety of Angioguard TM DPD in STEMI emergency PCI. Methods From July to December 2002, 40 STEMI patients undergoing emergency PCI were enrolled in the study, including 21 Angioguard TMDPD patients and 19 control patients. The basic clinical conditions, radiographic findings, interventional outcomes and follow-up during hospitalization were compared between the two groups. TIMI grading, TIMI frame and myocardial Blush grading were all performed after angioplasty. Results In AngioguardTM DPD group, 19 cases were successful (90 4%), and there were many thrombus-like substances in the baskets. The baseline clinical status, preoperative angiography and postoperative TIMI grade 3 (100% and 84%, P = 0 2 3) were not significantly different between the two groups. However, distal small vessel embolism occurred between the DPD group and the control group (52% and 368%, P = 0 042). The TIMI frames in both groups were (19 9 ± 5 7 and 30 3 ± 9 6 , P <0 0 0 1). The Blush 3-level acquisition rates were (73 7% and 31 6%, P = 0 0 2 2). Postoperative CK peak concentration was lower in the DPD group than in the control group (P <0.05). The ST segment depression rate was high and the left ventricular ejection fraction was higher recently. No major cardiovascular events occurred during hospitalization in both groups. Conclusion In some patients with STEMI, AngioguardTM DPD is safe and feasible in the emergency PCI, which can improve distal myocardial perfusion and improve cardiac function. Applying the TIMI frame method and the Blush grading method is superior to applying the TIMI grading method.