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目的单中心前瞻性随机比较急性下壁心肌梗死(AIMI)患者施行 PCI 前应用Guardwire Plus 与 Diver CE 两种血栓去除装置的效果。方法采用单中心前瞻性随机方法比较发病<12 h、TIMI 血流0～1级 AIMI 患者施行直接 PCI 前应用 Guardwire Plus 与 Diver CE 两种血栓去除装置的有效性。主要终点是 PCI 后1 h 内 ST 段回落程度。结果 122例患者人选本研究。Diver CE 组和 Guardwire Plus 组的年龄[(59.6±14)岁比(60.1±13)岁]、男性(82%比84%)、糖尿病(31%比28%)、既往冠心病(25%比23%)、症状发作到直接 PCI 时间[(550±185)rain比(345±180)min]和应用血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂(11%比13%)等基线资料均匹配。两组 ST 段回落(70%)率(57%比59%)、慢血流和无再流发生率(8%比7%)、TIMI 血流3级率(95%比97%)和心肌染色血流3级率(70%比72%)差异均无统计学意义(P>0.05)。术后1个月临床结果显示,左心室射血分数[(0.54±0.12)比(0.53±0.11)]、死亡(3%比3%)、再次心肌梗死(2%比0)和靶血管重建(2%比2%)差异也无统计学意义(P>0.05)。结论与 Guardwire Plus 装置比较,在 AIMI 患者施行支架术前应用 Diver CE 装置去除血栓,同样可以降低远端栓塞、促进 ST 段回落并改善心肌灌注。
Objective Single-center, prospective, randomized, comparative study of the effects of both Guardwire Plus and Diver CE thrombectomy devices on patients with acute inferior myocardial infarction (AIMI) before PCI. Methods A single-center, prospective, randomized trial comparing the efficacy of Guardwire Plus and Diver CE thrombectomy devices before PCI was performed in patients with TIMI grade 0 to 1 AIMI who had a history of onset <12 h. The primary endpoint was the degree of ST-segment fall within 1 h after PCI. Results 122 patients were selected for this study. Age (59.6 ± 14) years (60.1 ± 13) years], men (82% vs 84%), diabetes (31% vs 28%), previous coronary heart disease (25% vs 23%). Baseline data were matched for onset of symptoms until PCI (550 ± 185 min vs 345 ± 180 min) and platelet glycoprotein IIb / IIIa receptor antagonist (11% vs 13%) . Both ST-segment regression (70%) (57% vs. 59%), slow and no-reflow (8% vs 7%), TIMI 3 (95% vs 97% There was no significant difference in the grade 3 (70% vs 72%) staining blood flow (P> 0.05). One month after surgery, left ventricular ejection fraction [(0.54 ± 0.12) vs (0.53 ± 0.11)], death (3% vs 3%), recurrent myocardial infarction (2% vs 0), and target revascularization (2% vs 2%) was also no significant difference (P> 0.05). Conclusions Compared with the Guardwire Plus device, the Diver CE device can be used to remove thrombus before stent implantation in patients with AIMI, which can also reduce distal embolization, promote ST segment depression and improve myocardial perfusion.