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目的评价PercuSurge GuardWire远端保护装置对接受直接经皮冠状动脉介入治疗(PCI)的急性心肌梗死患者冠脉血流和心肌灌注水平的影响。方法入选在胸痛出现12 h内接受了直接PCI治疗的112例ST段抬高型急性心肌梗死患者,要求梗死相关血管狭窄≥70%且TIMI血流≤2级。PCI前接受了溶栓治疗者,左主干病变。参考血管直径<3.0mm且心功能Ⅳ级或心源性休克患者被剔除。患者随机分为2组,一组共56例患者应用PercuSurge Guardwire远端保护装置,另一组未接受远端保护装置的60例患者作为对照组。围手术期不使用GpⅡb/Ⅲa受体拮抗剂,保护球囊位置为右冠状动脉后降支分叉之前或中段前降支或回旋支远端。在病变被扩张之前,抽吸导管来回往返抽吸血栓和斑块碎屑数次。对比2组梗死相关动脉的冠脉TIMI血流和梗死区心肌灌注水平(MBG)的不同。结果远端保护装置应用组TIMI3级血流和梗死区心肌灌注水平的比例分别为96%和64%,明显高于对照组的80%和33%。结论直接PCI时应用远端保护装置能显著改善急性心肌梗死患者冠脉血流和心肌灌注水平。
Objective To evaluate the effects of PercuSurge GuardWire distal protection on coronary blood flow and myocardial perfusion in patients with acute myocardial infarction undergoing direct percutaneous coronary intervention (PCI). Methods One hundred and twelve patients with ST-segment elevation acute myocardial infarction undergoing direct PCI within 12 h of chest pain were enrolled, requiring ≥ 70% infarction-related vascular stenosis and TIMI flow ≤ 2. Patients undergoing thrombolysis prior to PCI had a left main lesion. Reference blood vessels <3.0 mm in diameter and patients with cardiac function grade IV or cardiogenic shock were excluded. The patients were randomly divided into two groups. A total of 56 patients were treated with the PercuSurge Guardwire distal protection device and the other 60 patients without the distal protection device were used as the control group. Perioperative Gp Ⅱ b / Ⅲ a receptor antagonist is not used to protect the location of the right coronary artery after coronary artery descending branch before or in the anterior descending or supination branch distal. Before the lesion is dilated, the aspiration catheter reciprocates the thrombus and plaque debris back and forth several times. The TIMI flow in coronary infarction-related artery and myocardial perfusion level (MBG) in infarction area were compared between two groups. Results The ratios of TIMI3 grade myocardial infarction and myocardial perfusion in distal protective device group were 96% and 64% respectively, which were significantly higher than 80% and 33% in control group. Conclusion The application of distal protection device in direct PCI can significantly improve coronary blood flow and myocardial perfusion in patients with acute myocardial infarction.