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急诊PCI中血栓病变的CAG特征和处理策略对心肌灌注的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2007年第6期
页码:
675-678
栏目:
临床研究
出版日期:
2007-12-20

文章信息/Info

Title:
Characteristics of coronary artery angiography of containingthrombi lesions and treatment strategy in emergency percutaneous coronary intervention
作者:
刘振江; 胡信群; 方臻飞; 刘启明; 沈向前; 周胜华
中南大学湘雅二医院心血管内科，湖南 长沙，410011
Author(s):
LIU Zhen-jiang;  HU Xin-qun;  FANG Zhen-fei;  LIU Qi-ming;  SHEN Xiang-qian;  ZHOU Sheng-hua
Department of Cardiology, Xiangya Second Hospital, Central South University, Changsha 410011, Hunan, China
关键词:
冠状动脉疾病; 经皮冠状动脉介入术; 血栓; 心肌灌注
Keywords:
coronary disease;  myocardial perfusion;  thrombus;  percutaneous coronary interventions.
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 研究急性心肌梗死（AMI）患者行经皮冠状动脉介入治疗（PCI）时，血栓病变的冠状动脉造影（CAG）特征以及处理策略对心肌灌注及短期预后的影响。方法 收集2002~2006年诊断为AMI并接受PCI治疗的114例患者，评价血栓病变的CAG特征，并根据术后TMP分级将患者分为心肌灌注良好组（TMP分级Ⅲ级）和不良组（TMP<Ⅲ级），采用 logistic回归分析影响术后心肌灌注不良和短期预后的因素。结果 114例患者中25例患者术后TMP分级＜Ⅲ级，3种影像学特征是术后心肌灌注不良的独立预测因素：罪犯血管直径大于4 mm （OR=5.23,95%CI,4.10-10.78，P=0.021），次全闭塞病变中血栓的长度大于病变血管参考直径（RLD）3倍（OR=1.47,95%CI,1.10-3.05,P=0.039）、闭塞段开通后远端见血栓（OR=3.38,95%CI, 2.12-5.49,P=0.044）。住院期间主要心血管事件（MACE）的危险因素是闭塞段开通后远端见血栓（OR=6.84,95%CI, 2.11-9.04,P=0.035），血栓抽吸器的应用是术后心肌灌注（OR=0.66，95%CI，0.44-0.92，P=0.009）和MACE的保护因素（OR=0.58,95%CI, 0.44-0.95,P=0.041）。结论 AMI患者的PCI术中血栓病变的影像学特征和术后心肌灌注不良及短期预后显著相关，血栓抽吸导管应用可以减少其影响。
Abstract:
AIM To study the coronary artery angiography characteristics of containingthrombi lesions, the treatment strategy and the shortterm prognosis in the emergency PCI. METHODS One hundred and fourteen acute myocardial infarction (AMI) patients were included in the study. Emergency PCI was performed, the coronary artery angiography characteristics of containingthrombi lesions were evaluated, and the myocardial perfusion levels of patients were assessed by the TMP (TIMI myocardial perfusion). Stepwise logistic regression analysis was employed to determine the independent predictors of low TMP grades and the MACE (major cardiovascular events) after PCI. RESULTS Twentyfive of the 114 patients had the 12 grades TMP after PCI. Three independent predictors of low TMP grade after PCI were found: the lumen diameter of the culprit vessels ≥4 mm（OR=5.23, 95%CI, 4.10-10.78, P=0.021）, incomplete obstruction lesions with thrombus three times longer than the reference lumen diameter of the culprit vessels（OR=1.47, 95%CI, 1.10-3.05, P=0.039）, and the presence of angiographic thrombus after the obstruction vessels were opened（OR=3.38, 95%CI, 2.12-5.49, P=0.044）. The third one was also the independent predictor of MACE (major cardiovascular events) (OR=6.84, 95%CI, 2.11-9.04, P=0.035）. The use of thrombusaspirating devices was the protective factor for low TMP grade after PCI (OR=0.66, 95%CI, 0.44-0.92, P=0.009) and the MACE (OR=0.58, 95%CI, 0.44-0.95,P=0.041). CONCLUSION The high thrombus burden characteristics of the culprit vessels in AMI patients are correlated with the shortterm prognosis and the bad myocardial perfusion after PCI. The use of thrombusaspirating devices can protect the patients from abnormal myocardial perfusion and poor prognosis.

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备注/Memo

备注/Memo:
收稿日期：2006-11-01 作者简介：刘振江,博士生 Email：zhenjliu@163.com
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