血栓抽吸联合重组人尿激酶原对急性心肌梗死急诊PCI术后慢血流或无复流的影响
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摘要
目的:探讨血栓抽吸联合重组人尿激酶原对急性ST段抬高型心肌梗死(STEMI)高血栓负荷患者经急诊冠状动脉介入术(PCI)治疗后发生慢血流或无复流现象的影响。方法:回顾性分析2015-01-2018-08于河北省人民医院心脏中心行急诊PCI治疗的高血栓负荷STEMI患者279例,其中80例经血栓抽吸导管行血栓抽吸(血栓抽吸组),62例通过指引导管冠脉内应用重组人尿激酶原(冠脉溶栓组),65例行血栓抽吸后通过血栓抽吸导管靶血管内应用重组人尿激酶原(联合治疗组),72例直接PCI治疗(直接PCI组)。观察4组患者慢血流或无复流发生情况,应用单因素分析方法筛选与慢血流或无复流相关的临床指标,进一步行多因素logistic回归分析急诊PCI后发生慢血流或无复流的独立危险因素。结果:4组患者慢血流或无复流现象发生率均差异有统计学意义,联合治疗组慢血流或无复流的发生率低于另外3组(均P<0.05);多因素logistic回归分析显示,再灌注时间(OR=2.986,95%CI:2.160～4.129,P<0.001)、BMI(OR=1.698,95%CI:1.416～2.036,P<0.001)及直接PCI(OR=7.255,95%CI:2.492～21.123,P<0.001)是STEMI患者急诊PCI术后出现慢血流或无复流现象的独立危险因素,血栓抽吸联合重组人尿激酶原治疗(OR=0.224,95%CI:0.061～0.829,P=0.025)是慢血流或无复流的保护性因素。结论:血栓抽吸联合重组人尿激酶原治疗可降低STEMI高血栓负荷患者急诊PCI术后慢血流或无复流的发生率。
Objective:To evaluate the impact of thrombus aspiration combined with recombinant human prourokinase on slow/no-reflow phenomenon after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Method:We retrospectively evaluated 279 STEMI patients with high blood burden who underwent emergency PCI from January 2015 to August 2018 in Hebei Provincial People's Hospital.Among them,80 patients underwent thrombus aspiration(thrombus aspiration group),62 patients were treated with recombinant human prourokinase through guiding catheter(coronary thrombolysis group),65 patients underwent thrombus aspiration combined with recombinant human prourokinase(combination group)and 72 patients were treated with direct PCI(direct PCI group).The occurrence of slow/no-reflow in four groups was observed.Univariate analysis was used to screen clinical indicators related to slow/no-reflow,multivariate logistic regression was used to analyze independent risk factors of slow/no-reflow after emergency PCI.Result:There were statistically significant differences in the incidence of slow/no-reflow in four groups,the incidence of slow/no-reflow in combination group was lower than those in other three groups(all P<0.05).Multivariate logistic regression analysis showed that reperfusion time(OR=2.986,95%CI:2.160-4.129,P<0.001),body mass index(OR=1.698,95%CI:1.416-2.036,P<0.001),direct PCI(OR=7.255,95%CI:2.492-21.123,P<0.001)were independent risk factors influencing the occurrence of slow/no-reflow after emergency PCI in STEMI patients.In addition,thrombus aspiration combined with recombinant human prourokinase was a protective factor for slow/no-reflow(OR=0.224,95%CI:0.061-0.829,P=0.025).Conclusion:Thrombus aspiration combined with recombinant human prourokinase therapy can reduce the incidence of slow/no-reflow after emergency PCI in STEMI patients with high blood burden.
Objective:To evaluate the impact of thrombus aspiration combined with recombinant human prourokinase on slow/no-reflow phenomenon after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Method:We retrospectively evaluated 279 STEMI patients with high blood burden who underwent emergency PCI from January 2015 to August 2018 in Hebei Provincial People's Hospital.Among them,80 patients underwent thrombus aspiration(thrombus aspiration group),62 patients were treated with recombinant human prourokinase through guiding catheter(coronary thrombolysis group),65 patients underwent thrombus aspiration combined with recombinant human prourokinase(combination group)and 72 patients were treated with direct PCI(direct PCI group).The occurrence of slow/no-reflow in four groups was observed.Univariate analysis was used to screen clinical indicators related to slow/no-reflow,multivariate logistic regression was used to analyze independent risk factors of slow/no-reflow after emergency PCI.Result:There were statistically significant differences in the incidence of slow/no-reflow in four groups,the incidence of slow/no-reflow in combination group was lower than those in other three groups(all P<0.05).Multivariate logistic regression analysis showed that reperfusion time(OR=2.986,95%CI:2.160-4.129,P<0.001),body mass index(OR=1.698,95%CI:1.416-2.036,P<0.001),direct PCI(OR=7.255,95%CI:2.492-21.123,P<0.001)were independent risk factors influencing the occurrence of slow/no-reflow after emergency PCI in STEMI patients.In addition,thrombus aspiration combined with recombinant human prourokinase was a protective factor for slow/no-reflow(OR=0.224,95%CI:0.061-0.829,P=0.025).Conclusion:Thrombus aspiration combined with recombinant human prourokinase therapy can reduce the incidence of slow/no-reflow after emergency PCI in STEMI patients with high blood burden.
引文
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[10]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[11]Jolly SS,Cairns JA,Yusuf S,et al.Outcomes after thrombus aspiration for ST elevation myocardial infarction:1-year follow-up of the prospective randomised TOTAL trial[J].Lancet,2016,387(10014):127-135.
[12]Lagerqvist B,Fr9bert O,Olivecrona GK,et al.Outcomes 1year after thrombus aspiration for myocardial infarction[J].N Engl J Med,2014,371(12):1111-1120.
[13]冯嘉旭,张卫泽,王海昌,等.血栓抽吸在急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗中的应用[J].临床心血管病杂志,2016,32(1):4-11.
[14]Boscarelli D,Vaquerizo B,Miranda-Guardiola F,et al.Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration[J].Eur Heart J Acute Cardiovasc Care,2014,3(3):229-236.
[15]Sun Y,Liu X,Guo L,et al.HTUPA as a new thrombolytic agent for acute myocardial infarction:a multicenter,randomized study[J].Int J Cardiol,2014,172(2):326-331.
[2]Sabin P,Koshy AG,Gupta PN,et al.Predictors of noreflow during primary angioplasty for acute myocardial infarction,from Medical College Hospital,Trivandrum[J].Indian Heart J,2017,69Suppl 1:S34-34S45.
[3]Soeda T,Higuma T,Abe N,et al.Morphological predictors for no reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction caused by plaque rupture[J].Eur Heart J Cardiovasc Imaging,2017,18(1):103-110.
[4]李晨曦,周静,李飞,等.重组人尿激酶原对STEAMI患者急诊PCI术中无复流的影响[J].医学综述,2016,22(7):1421-1423.
[5]韩俊愈,李卫华,谢强,等.冠状动脉内注射硝普钠与硝酸甘油在急性心肌梗死急诊手术中的临床对照研究[J].临床心血管病杂志,2017,33(6):531-533.
[6]Mahmoud KD,Zijlstra F.Thrombus aspiration in acute myocardial infarction[J].Nat Rev Cardiol,2016,13(7):418-428.
[7]Svilaas T,Vlaar PJ,van der Horst IC,et al.Thrombus aspiration during primary percutaneous coronary intervention[J].N Engl J Med,2008,358(6):557-567.
[8]Shiraishi J,Kohno Y,Nakamura T,et al.Clinical impact of thrombus aspiration during primary percutaneous coronary intervention in acute myocardial infarction with occluded culprit[J].Cardiovasc Interv Ther,2015,30(1):22-28.
[9]刘伶,徐广马,林虹,等.血栓抽吸在老年急性ST段抬高型心肌梗死患者直接介入治疗中的应用[J].临床心血管病杂志,2011,27(12):945-947.
[10]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[11]Jolly SS,Cairns JA,Yusuf S,et al.Outcomes after thrombus aspiration for ST elevation myocardial infarction:1-year follow-up of the prospective randomised TOTAL trial[J].Lancet,2016,387(10014):127-135.
[12]Lagerqvist B,Fr9bert O,Olivecrona GK,et al.Outcomes 1year after thrombus aspiration for myocardial infarction[J].N Engl J Med,2014,371(12):1111-1120.
[13]冯嘉旭,张卫泽,王海昌,等.血栓抽吸在急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗中的应用[J].临床心血管病杂志,2016,32(1):4-11.
[14]Boscarelli D,Vaquerizo B,Miranda-Guardiola F,et al.Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration[J].Eur Heart J Acute Cardiovasc Care,2014,3(3):229-236.
[15]Sun Y,Liu X,Guo L,et al.HTUPA as a new thrombolytic agent for acute myocardial infarction:a multicenter,randomized study[J].Int J Cardiol,2014,172(2):326-331.