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Background: Thrombus embolization during the Percutaneous Coronary Intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is common and results in suboptimal myocardial perfusion and increased infarct size. Two strategies proposed to reduce distal embolization and improve outcomes after primary PCI is bolus intracoronary Abciximab and manual aspiration thrombectomy. There are several factors which influence the decision of primary PCI in a patient with AMI in developing countries. Cost of therapy and affordability is probably the most important factor. The additional cost for thrombus aspiration needs to be considered against the additional advantages in terms of better clinical outcome. Objectives: To compare the use of a combination of intracoronary Abciximab with manual thrombus aspiration to intracoronary Abciximab alone, in patients with STEMI undergoing primary PCI. Patients and Methods: This is a prospective observational study of patients with STEMI who underwent primary PCI between June 2018 to May 2019. A pre-approved study protocol was designed to determine the eligibility of STEMI patients to be included in the study. Patients with The patients have analysed in two groups: 84 patients received a combination of intracoronary Abciximab with manual thrombus aspiration & 80 patients received intracoronary Abciximab alone. The primary endpoint was the assessment of myocardial perfusion parameters namely Myocardial Blush Grade (MBG) in the culprit vessel & ST-segment resolution of >70% on ECG at 90 min after PCI. Secondary endpoints were the improvement in LV ejection fraction, cardiovascular mortality & recurrent MI at one-month post-procedure. Results: Result of the 84 patients who received combination of intracoronary Abciximab with manual thrombus aspiration, the primary endpoints namely the myocardial blush grade (MBG) of 2/3 was achieved in 72 patients (90.74%) & ST-segment resolution of >70% at 90 min was seen in 66 patients (78.57%) (p<0.001). Of the 80 patients who received only intracoronary Abciximab without thrombus aspiration, MBG 2/3 was achieved in 38 patients (47.5%) & ST-segment resolution of >70% at 90 min was seen in 28 patients (35%). At one month of follow up the secondary endpoints namely the LVEF in the combination group improved from 43.42±3.73 to 47.88±4.16% (p=0.12)and in the Abciximab group improved from 44.78±3.34 to 46.20±3.63%. Recurrent MI was seen in one patient in the combination group (p<0.001) & two patients in the ic Abciximab group. There was no cardiovascular mortality noted in the present study (p<0.001). Conclusion: Intracoronary Abciximab + manual thrombus aspiration reduces thrombus burden with better results in microvascular perfusion assessed by ST-segment resolution of >70% at 90 min & higher Myocardial Blush Grade compared to intracoronary Abciximab alone in patients with STEMI undergoing primary PCI.
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Coronary disease is one of the highest mortality diseases in the world,and interventional therapy has been the best treatment choice for its low risks,high efficiency,less wound and rapid recovery after the operation.Thrombus aspiration catheter is one of the most important equipment in the interventional therapy instrument of coronary disease.This paper is based on the demand of clinical and market,designed and manufactured aspirated catheter for the treatment of coronary thrombosis.Through the performance comparison of the material,confirmed the main material quality of thrombus aspiration catheter and its organization.We also made the appraisement for the function of the material and the main performance of the thrombus aspiration catheter.The experiment turned out that our catheter performance is stable and also with highly reliable,which is absolutely fit for the using requirements of the clinical.
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Humans , Catheters , Coronary Angiography , Coronary Thrombosis , Therapeutics , Suction , Thrombectomy , Treatment OutcomeABSTRACT
Objective@#To investigate the effect of thrombus aspiration during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI).@*Methods@#This retrospective study included 321 STEMI patients who underwent PPCI at Beijing Chaoyang hospital from January 2013 to March 2014. Patients were divided into the PPCI group (189 cases) and the PPCI plus thrombus aspiration group (132 cases). Baseline and perioperative clinical data, procedural characteristics were collected, and primary endpoint events including all-cause death, re-myocardial infarction, and coronary revascularization and secondary endpoint events including cardiac death, recurrent angina, target lesion revascularization, and stent thrombosis were recorded during the follow-up.@*Results@#There were no significant difference between PPCI group and PPCI plus aspiration group in age ((59.8±12.5) years old vs. (58.3±14.4) years old, P=0.060) and male ratio (82.5% (156/189) vs. 82.6% (109/132), P=0.993). The number of disease vessels (1.59±0.81 vs. 1.47±0.70, P=0.039) and the prevalence of left anterior descending as infarction related artery (52.3% (69/132) vs. 38.6% (73/189), P=0.022) were significantly higher in the PPCI plus aspiration group than that in the PPCI group.The symptom onset time (3.0 (2.0,4.8) hours vs. 4.0 (2.0,7.0) hours, P=0.027) and myocardial ischemia time (3.9 (2.7,6.2) hours vs. 4.7 (2.9,7.9) hours, P=0.022) were significantly in the PPCI plus aspiration group than in the PPCI group. The percent of thrombolysis in myocardial infarction (TIMI) thrombosis score≥ grade 4 (92.4% (122/132) vs. 75.1% (142/189), P<0.001)and postoperative TIMI flow grade 3 (70.5% (93/132) vs. 60.8% (115/189), P=0.003) was significantly higher in the PPCI plus aspiration group than in the PPCI group. The PPCI group patients were followed up for (31.6±7.5) months, and PPCI plus aspiration group patients were followed up for (32.2±6.7) months (P=0.466). During the follow-up period, there was no significant difference in the incidence of primary endpoint events between the PPCI plus aspiration group and the PPCI group (17.1% (22/129) vs. 16.9% (31/184), P=0.962). Recurrent angina was more frequent in the PPCI plus aspiration group than in the PPCI group (25.6% (33/129) vs. 16.3% (30/184), P=0.044). There was no significant difference in cardiac death (3.1% (4/129) vs. 3.3% (6/184), P=1.000), target lesion revascularization (3.9% (5/129) vs. 3.3% (6/184), P=0.765), and stent thrombosis (3.1% (4/129) vs. 2.7% (5/184), P=1.000) between the PPCI plus aspiration group and the PPCI group. Multivariate Cox regression analysis showed that the number of diseased vessels (RR=1.901, 95%CI 1.217-2.970, P=0.005) and postoperative TIMI flow grade (RR=0.455, 95%CI 0.221-0.934, P=0.032) were the risk factors for coronary revascularization after PPCI. The number of diseased vessels was a risk factor for major endpoint events after PPCI (RR=1.421, 95%CI 1.017-1.986, P=0.040).@*Conclusion@#The incidence of clinical events is similar in patients with STEMI treated with PPCI alone or PPCI plus aspiration.
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Objective To observe the impact of enhancing perioperative care on the clinical efficacy of the patients with intravascular intervention for treatment of patients with acute lower extremity deep venous thrombosis (LEDVT) complicated with pulmonary embolism (PE). Methods Twenty-nine patients with LEDVT complicated with PE admitted to the Tianjin First Center Hospital from May 2015 to February 2019 were enrolled, the pulmonary angiography + pulmonary thrombolysis was applied for all the patients, and 25 cases used inferior vena cava filter implantation, 1 patient underwent catheter-directed thrombolysis (CDT), 4 patients underwent mechanical endovascular aspiration of thromboembolism (PTM), etc intravascular interventional treatment, the peri-operative care was strengthened, including closely observation on the patient's condition, correct use of anticoagulant and thrombolytic drugs, in the mean time, after operation, the nursing care and observation on thrombolysis catheters, involved limbs, complications should be well performed, and health education and discharge guidance ought to be carried out. Before the patient was discharged from the hospital, the improvement of clinical symptoms and the changes of coagulation indexes D-dimer, fibrinogen (Fib), prothrombin time (PT), and activated partial thromboplastin time (APTT) were observed; the Bartel index evaluation quantitative scale was used to assess the patient's activity of daily living (ADL) score; WeChat was used to investigate patient's satisfaction. Results In this group of 29 patients, postoperative chest tightness, shortness of breath symptoms were improved significantly, no fatal PE etc complications occurred. The pulmonary artery computed tomographic angiography (CTA) showed that the pulmonary artery and its branches PE basically disappeared or the measured range or area was obviously decreased. Re-examination of blood gas analysis showed that the arterial oxygen partial pressure (PaO2) was increased. Echocardiography revealed the improvement in pulmonary hypertension. 12 patients with pulmonary infection were improved after anti-inflammatory treatment, the swelling of the affected limb was significantly relieved, and the patients had no distending pain after activities on the ground. After treatment, the coagulation indexes D-dimer and fibrinogen (Fib) were significantly lower than those before treatment [D-dimer (μg/L):2 389.45±2 061.02 vs. 6 093.45±2 586.99, Fib (g/L): 3.18±0.91 vs. 4.07±1.49, both P < 0.01], there were no significant differences in PT and APTT before and after treatment [PT (s): 13.12±2.27 vs. 12.33±2.06, APTT (s):34.51±11.79 vs. 31.84±3.05, both P > 0.05]. After treatment, the ADL score of patients was obviously higher than that before treatment (scores: 79.66±6.26 vs. 17.24±8.30, P < 0.01). WeChat was used to investigate the patients' satisfaction, the nursing score was 95-100 points with an average of (97.38±1.37) points. Conclusion High quality nursing care can minimize the suffering to the largest extent in the patients with pulmonary thrombosis, elevate the quality of life, and reduce the disability and recurrence rates.
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Objective To compare the effects of ticagrelor and clopidogrel on levels of inflammatory factors after emergent percutaneous coronary intervention (PCI) combined with thrombus aspiration in patients with acute myocardial infarction (AMI). Methods Two hundreds and sixteen patients with AMI undertaking emergent PCI plus thrombus aspiration admitted to Cangzhou Central Hospital from April 2014 to April 2017 were enrolled, and they were randomly assigned into a ticagrelor group and a clopidogrel group, each group 108 cases. After admission, the clopidogrel group received 300 mg aspirin and 300 mg clopidogrel loading, after operation, aspirin 100 mg and clopidogrel 75 mg were given, once a day maintaining for 12 weeks; ticagrelor group after admission received 300 mg aspirin and 180 mg ticagrelor loading and after operation 100 mg aspirin (once per day) and 90 mg ticagrelor (twice per day) were given, maintaining for 12 weeks. Venous blood was taken immediately after admission and 24 hour and 1, 4, and 12 weeks after PCI plus thrombus aspiration, and the plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6) and soluble CD40 ligand (sCD40L) were measured by double antibody enzyme linked immunosorbent assay (ELISA). Results Twenty-four hours after the operation, the levels of inflammatory factors, CRP, IL-6 and sCD40L were significantly higher than those before operation, the levels of the above inflammatory factors continued to decrease at the time points 1, 4, and 12 weeks later, reaching the lowest level at 12 weeks, and the above levels in ticagrelor group were significantly lower than those in clopidogrel group [CRP (μg/L): 2.96±0.63 vs. 4.44±0.34, IL-6 (ng/L): 2.50±0.51 vs. 2.81±0.21, sCD40L (ng/L): 519.60±12.53 vs. 570.25±11.55, all P < 0.05]. Conclusion The anti-inflammatory effect of ticagrelor is greater and more durable than that of clopidogrel after emergent PCI plus thrombus aspiration in patients with AMI.
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Objective To investigate the effectiveness of combination treatment of thrombus aspiration and ischemic post-condition on patients with acute ST elevated myocardial infarction(SETMI) undergoing primary percutaneous coronary intervention. Methods A total of 234 patients were randomly divided into two groups: one group received routine treatment (control group, n=111); while another group received the combination treatment of thrombus aspiration and ischemic post-conditioning (treatment group, n=123). The baseline data, coronary lesion, information of percutaneous coronary intervention, data of reperfusion and in-hospital clinical prognosis of the two groups were evaluated. Results The baseline data of the two groups are comparable except TG level was higher in treatment group. Compared with the control group, the peak value of cardiac enzyme was lower while the rate of immediate ST resolution to baseline was higher with less MACE during hospitalization in the treatment group. Other data were all comparable between the two groups. Conclusions The combination of thrombus aspiration and ischemic post-conditioning during primary PCI in patients with acute myocardial infarction can restore cardiac perfusion and reduce MACE during hospitalization.
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Objective To investigate the diff erential expression of microRNA in microparticles from coronary blood and peripheral blood in patients with acute myocardial infarction, and to provide clues for further study on the role of myocardial in the pathogenesis of myocardial infarction. Methods Coronary and peripheral blood samples were collected from patients with acute myocardial infarction undergoing thrombus aspiration. Microparticles from coronary and peripheral blood samples were isolated by centrifugation and gene chips were used to sequence the microRNA from the microparticles in the two groups. The diff erences in microRNA expression were identifi ed between two groups and the function of these microRNA were analyzed. Results There were signifi cant diff erences between the microRNA in the microparticles from the coronary blood and peripheral blood in patients with acute myocardial infarction. By constructing expression profi les, 307 diff erentially expressed microRNA were found, with 221 of them were up regulated and 86 of them were down regulated. Conclusion There is signifi cant diff erence between the expression of microRNA in microparticles from the coronary blood and the peripheral blood of patients with acute myocardial infarction forty nine of them are closely related to cardiovascular disease, which can be used as the target of further research.
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Objective To investigate the interventional therapy effect of combination application of thrombus aspiration and intracoronary injection of tirofiban for treating heavy thrombosis burden of infarction related vessel in the patients with acute anterior myocardial infarction.Methods The patients with acute anterior myocardial infarction undergone direct primary percutaneous coronary intervention in the hospital were retrospectively analyzed.The group A received simple thrombus aspiration during transcutaneous PCI and the group B received the combination treatment of thrombus aspiration and intracoronary injection of tirofiban in direct PCI.Results The patients with myocardial perfusion grade less than 3 during thrombolysis during myocardial infarction(TIMI) in the group B were significantly less than those in the group A(P＜0.05).The cardiac magnetic resonance imaging(MRI) results indicated that the area of myocardial infarction in the group B was smaller than that in the group A(P＜0.05).The color echocardiography results showed that the left ventricular diastolic volume(LVDV) and left ventricular ejection fraction(LVEF) in the group B were significantly better than those in the group A(P＜0.05).Conclnsion The combination application of thrombus aspiration and intracoronary injection of tirofiban is safe and effective in direct PCI.
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Objective To investigate the effects of distal thrombolysis versus thrombus aspiration on myocardial perf usion and prognosis in patients with acute ST segment elevation myocardial infarction(AMI)during emergency percutaneous coronary intervention(PCI). Methods 96 patients with acute ST segment elevation myocardial infarction(onset<6 hours)were randomly divided into thrombolysis group and distal thrombus aspiration group. Patients in the distal thrombolysis group(n=46)received transcatheter urokinase injection to the occlusive segment followed by balloon dilatation or stenting. Patients in the thrombus aspiration group(n=50)were given thrombus aspiration after balloon angioplasty or stenting. Patients were followed up for 30 days after operation. The coronary blood flow and myocardial perfusion were compared between the 2 groups. The incidence of major adverse cardiac events(MACE)and left ventricular systolic function after 30 days were compared. Results There was 1 case in the distal thrombolysis group (0.2%)and 6 case in the thrombus aspiration group(12%)presented with TIMI fl ow≤grade Ⅱ(P=0.008). A 65.2% of patients in the distal thrombolysis and 42.0% of patients in the thrombus aspiration group achieved > 50% of ST segment resolution in 2 hours(P=0.019). At 30-day follow up,the LVEF was found higher in the thrombolysis group compared with the aspiration group(54.1±8.6)% vs.(50.8±7.3)%,P=0.047 but the LVEDD(44.3±7.2)mm vs.(46.5±6.8)mm,P=0.038 and NT-proBNP levels(117.8±71.8)μg/L vs.(161.2±72.3)μg/L,P=0.025 were found significantly lower in the thrombolysis group. Conclusions For the ST segment elevation myocardial infarction,distal thrombolysis,when compared with thrombus aspiration,may reduce the incidence of slow flow and no reflow,and may improve the left ventricular systolic function.
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Objective To explore the clinical efficacy and outcomes of thrombus aspiration in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PPCI). Methods A total of 664 cases of STEMI patients undergoing PPCI from Tianjin Chest Hospital from January 2013 to March 2015 were retrospectively analyzed. Patients were divided into two groups:primary PCI after thrombus aspiration group and conventional primary PCI without thromobus aspiration group. The base-line clinical characteristics, and the procedure of percutaneous coronary intervention were similar between two groups. The TIMI flow, LVEF, one-month outcomes and 12-month outcomes were compared between two groups. Results There were significant higher TIMI flow, LVEF in primary PCI after thrombus aspiration group than those of conventional primary PCI without thromobus aspiration group (P<0.05). At one-month follow-up, there were no significant differences in major adverse cardiac events (MACE) between the two groups. At 12-month follow- up, there were no significant differences in cardiovascular death, recurrent myocardial infarction and new hospitalization between two groups. The incidence of recurrent angina was significantly higher in non-aspiration group than that in aspiration group (P<0.05). There were the better survival functions without MACE in aspiration group than that of control group. Conclusion Thrombus aspiration, as an adjunctive method to primary PCI for STEMI, may improve TIMI flow, have beneficial effects on LVEF and reduce the incidence of recurrent angina at 12-month follow up.
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Objective To analyze and summarize the treatment strategies for unstable angina with no-reflow phenomenon after PTCA during early percutaneous interventional procedures.Methods A total of 32 cases with unstable angina were divided into two groups:one group with drug therapy and the other group with drug therapy and thrombus aspiration catheter.The patients were chosen when there was no-reflow phenomenon after PTCA during early percutaneous interventional procedures and their clinical data were compared and analyzed.Blood flow TIMI grade,myocardial perfusion grade (MBG),TIMI myocardial perfusion (TMP) grade and other indexes were observed and recorded.Results The general conditions had no statistical difference between two groups.Compared with the drug therapy group,the proportion of patients with TIMI,MBG and TMP grade 3 was higher in aspiration and drug therapy group (89％ VS 71％ P＜0.05).Conclusion Drug therapy and thrombus aspiration catheter in treatment helps to improve myocardial perfusion level for unstable angina with no no-reflow phenomenon after PTCA during early percutaneous interventional procedures.
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Objective To assess impact of selective thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) on long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Methods Between Jan. 2008 and Jan. 2014, a total of 2357 STEMI patients [429 in thrombus aspiration (TA) group and 1928 in routine percutaneous coronsry intorventim (PCI) group (control group)] were eligible for the study criteria and candidates for pPCI were enrolled in this study. The reflow of the involved vessel in pPCI procedure, stent thrombosis and major adverse cardiac events (MACE) were comparatively analyzed in the two groups during hospital stay and 12-month follow-up period. Results Although the success rate of TA procedure was significantly lower in TA group compared with that in control group (P0.001), both the TIMI flow grade ≥2 after TA procedure and stent implantation occurred more frequently in TA group than in control group (P0.05). The rates of MACE and stent thrombosis showed no difference between two groups during in-hospital and 12-month follow-up period (P>0.05). But the rates of total MACE and target vessel revascularization were significantly higher in control group than in TA group (P=0.04). Conclusion Selective TA procedure before primary PCI could improve final myocardial reperfusion, reduce the incidence of MACE and improve the 1-year clinical result for STEMI patients.
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Objective To investigate the effect of thrombus aspiration on troponin I (cTnI) and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in the patients with acute myocardial infarction .Methods According to whether performing the thrombus aspiration therapy ,106 patients with acute myocardial infarction were divided the thrombus aspiration group (51 cases) and the di‐rect stenting group (55 cases) .The changes of cTnI and NT‐proBNP before and after treatment were compared between the two groups ,at the same time the occurrence rates of complications and postoperative cardiovascular events were also compared between the two groups .Results Compared with the stenting group ,the cTnI peak time in the aspiration group was in advance[(10 .2 ± 2 .9)h vs .(18 .3 ± 3 .6)h ,P< 0 .05] ;the peak value of cTnI in the aspiration group was decreased ,the differences had statistical sig‐nificance[(21 .9 ± 8 .8) ng/mL vs .(40 .3 ± 11 .8)ng/mL ,P< 0 .05] .The preoperative NT‐proBNP level in the two groups were in‐creased ,the NT‐proBNP level on postoperative 1 d in the aspiration group was lower than that in the stenting group with statistical difference[(7 084 .6 ± 735 .2) pg/mL vs .(14 109 .7 ± 849 .1) pg/mL ,P< 0 .05)] .5 cases of slow blood flow occurred in the stent‐ing group ,no case of slow blood flow or no blood flow phenomenon occurred in the aspiration group ,the difference was statistically significant(P< 0 .05) .After half a year of follow‐up ,4 cases of heart failure in the stenting group and 1 cases of heart failure in the aspiration group occurred ,the difference was statistically significant(P < 0 .05) .Conclusion The thrombus aspiration can reduce the occurrence of slow blood flow or no blood flow phenomenon in the interventional therapy ,cTnI and NT‐proBNP dynamic detec‐tion can provide the basis for judging the prognosis .
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Objective To evaluate the prognestic effect of thrombus aspiration combined tirofiban in patients of acute myocardial infarction. Methods 372 patients with acute ST segment elevation myocardial infarction were randomly divided into the observation group (n=183) and the control group (n=189). Patients in the observation group received thrombus aspiration combined tirofiban additional to conventional treatment, and cases in the control group received routine treatment. The curative effect, postoperative complications and adverse reactions were compared between the 2 groups. Results The postoperative TIMI classⅢperfusion was achieved in 152 cases (83.1%) in the observation group and 140 cases (74.1%) in the control group (P 0.05). MACE reorded within 30 d post operation was 10 cases(5.5%) in the observation group and 22 cases (11.6%) in the control group (P < 0.05). No thrombocytopenia recorded in both groups. Conclusions Thrombus aspiration combined tirofiban for patients with acute myocardial infarction during PCI can improve the postoperative coronary artery perfusion, left ventricular ejection function and reduce the incidence of MACE within 30 days.
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Objective: To evaluate the short-term effect of thrombus aspiration catheters combining tiroifban medication for myocardial tissue reperfusion recovery in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 105 STEMI patients with percutaneous coronary intervention (PCI) in our hospital from 2011-05 to 2013-05 were studied, there were 73 male and 32 female with the mean age of (58.39 ± 10.37) years. The patients were randomly divided into 2 groups, Group A, the patients received thrombus aspiration catheters with intravenous tiroifban, n=53 and Group B, the patients received tiroifban and PCI, n=52. The basic clinical features, myocardial tissue perfusion level, major adverse cardiovascular events (MACE) at post operative and in-hospital period were recorded, the cardiac function was examined by echocardiography at 6 months after PCI in both groups. Results: The basic clinical features were similar between 2 groups. The thrombolysis in myocardial infarction trial (TIMI) 3 lfow rate was higher in Group A than that in Group B (92.45% vs 55.77%), P=0.000. TIMI 2 and TIMI 0~1 lfow rates were lower in Group A than that in Group B (7.55%vs 26.92%), P=0.008 and (0%vs 17.31%), P=0.002. The adjusted TIMI frame was lower in Group A (27.26±5.50) vs (38.98±5.42), P0.05. Conclusion:Thrombus aspiration catheters combining tiroifban medication may obviously improve the myocardial tissue reperfusion and the short-term cardiac function in STEMI patients after PCI, it could reduce the incidence of no-relfow without increasing MACE.
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Objective To evaluate the effectiveness, safety and feasibility of the application of trans-radial thrombus aspiration in patient with heavy burden of thrombus receiving primary coronary interventional therapy. Methods 56 patients with acute coronary syndrome receiving primary coronary interventional therapy were enrolled and randomized to two groups. 31 patients received therapy of thrombus aspiration by Thrombuster II, while 25 patients received routine coronary interventional therapy. We compared the rate of major adverse cardiac event (MACE) in hospital, left ventricular ejection fraction (LVEF) one week post procedure and left ventricular end diastolic diameter (LVEDD), TIMI frame before and after procedure between two groups. Results The rate of MACE was signiifcantly (P<0.05) lower in patients receiving thrombus aspiration (3.3%) compared with routine PCI group (12.0%). LVEF and the rate of patients with TIMI Ⅲafter procedure were signiifcantly (P < 0.05) higher in patients receiving thrombus aspiration. There’s no significant difference in LVEDD between two groups. Conclusions There lies good safety and feasibility for applying thrombus aspiration combining direct PCI in patient with heavy burden of thrombus.
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Objective To evaluate the effects of thrombus aspiration on postoperative clinical prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients with emergency percutaneous coronary intervention(PCI).Methods From September 2009 to January 2012,a total of 239 patients with STEMI undergoing emergency PCI (thrombus aspiration + PCI (n =118) and PCI (n =121)) were enrolled in this study.The angiographic and clinical results were retrospectively analyzed and compared between the two groups of patients.Results There were significant differences between the thrombns aspiration group and the PCI group on instant blood flow TIMI3 grade (106 (89.8％) vs.96 (79.3％) ; x2 =5.026,P ＜ 0.05),ST-segment depression rate at two hours after surgery (101 (85.6％) vs.90 (75.2％) ; x2 =5.500,P ＜ 0.05),ejection fraction within one week after surgery (68 (57.6％) vs.52 (43.0％) ; x2 =5.130,P ＜ 0.05),incidence of reinfarction during hospitalization (0 (0) vs.5 (4.1％) ; x2 =4.980,P ＜ 0.05).There were no significant statistical difference between the two groups on the average length of stay ((10.05 ± 5.40) d vs.(10.40 ± 5.03) d; t =-0.525,P ＞ 0.05),incidence of ventricular fibrillation during surgery (4 (3.4％) vs.3 (2.5 ％ ; x2 =0.174,P ＞ 0.05),heart failure during hospitalization (15 (12.7％) vs.18 (14.9％) ; x2 =0.235,P ＞0.05),Malignant arrhythmias (12 (10.2％) vs.15 (12.4％) ; x2 =0.296,P ＞ 0.05),and mortality rate (2 (1.7％) vs.5(4.1％);x2 =1.248,P ＞0.05).Conclusion Application of thrombus aspiration,which is a safe and effective way,may improve the clinical outcomes in acute ST-segment elevation myocardial infarction patients with emergency PCI.
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Objective To observe the ZEEK thrombus aspiration catheter use on the level of vascular and myocardial perfusion in acute ST-segment elevation myocardial infarction (STEMI) patients,as well as the impact of early prognosis in order to clear the relative best use of ZEEK thrombus aspiration catheter.Methods Eighty-eight acute STEMI patients who underwent percutaneous coronary intervention (PCI),according to the direct use of ZEEK thrombus aspiration catheter or after pre-expansion with small balloon,divided into direct aspiration group 45 cases,and inflation pre-aspiration group 43 cases.All patients underwent stenting,observed the perfusion of the vascular and myocardial levels after stenting,after 1 month,determined N end of B type natriuretic peptide (NT-proBNP) level,observed segmental wall motion score index (WMSI) and left ventricular ejection fractions (LVEF).Results Direct aspiration group was significantly better than inflation pre-aspiration group in the TIMI frames count,rate of TIMI coronary myocardial perfusion grade 2-3 grade and after 2 h ST segment resolution ＞ 50％ rate [(31.3 ± 7.9) frames vs.(42.5 ± 8.5) frames,84.4％(38/45) vs.72.1％(31/43),86.7％(39/45) vs.74.4％(32/43),P＜0.01 or ＜ 0.05].After 1 month,direct aspiration group was significantly lower than inflation pre-aspiration group in the peak of creatine kinase isozyme MB,NT-proBNP and WMSI [(2141.3 ± 306.5)U/L vs.(2734.5 ± 366.1)U/L,(443.2 ± 226.4) ng/L vs.(512.9 ± 281.7) nig/L,1.32 ± 0.16 vs.1.59 ± 0.23,P ＜ 0.05],but there was no significant difference in LVEF between two groups (P ＞ 0.05).Conclusions Repeated aspiration to infarction responsibility lesion segments using ZEEK thrombus aspiration catheter,and direct stenting,which is superior to the thrombus aspiration and stenting placement after single or multiple pre-expansion.
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Objective To observe the safety and efficiency of DIVER thrombus aspiration catheter application during percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI)and to evaluate its impacts on the myocardial reperfusion,cardiac function and in-stent restenosis after 9months.Methods A total of 86 cases of ST-segment elevation patients of AMI treated with PCI and confirmed complete occlusion lesion by angiography from November 2008 to December 2010 were randomly divided into two groups:aspiration group(n =43)with DIVER thrombus aspiration cathetcrs were used,and non-aspiration group (n =43).ST-segment recovery within two hours,TIMI grade,the in-hospital adverse major cardiac events,the levels of Pro-BNP,coronary function determined by ultrasound heartbeat graph and the results of coronary angiography after PCI for 9 months were compared between two groups.Results There was significant difference on ST-segment recovery within two hours between these two groups[95.35％(41/43)vs 79.02％(34/43),x2 =11.862,P =0.0006].The incidence of TIMI 3 grade flow was significantly higher,the incidence of TIMI 2(slow flow)and TIMI 0-1(no-reflow)grade flow were much lower in aspiration group than those in non-aspiration group immediately after PCI[TIMI 3:93.02％(40/43) vs 81.40％(35/43),x2 =6.06,P =0.0335 ; TIMI 2:6.98％(3/43) vs 13.95 ％(6/43),x2 =3.12,P =0.0495 ; TIMI 0-1:0 vs 6.98 ％(3/43),x2 =5.29,P =0.0352].There was no difference on LVEF[(0.420±0.054) ％ vs(0.408±0.052)％,t =1.0496,P =0.766and LVEDD(56.5±4.5)mm vs(57.6±4.4)mm,t =1.0419,P =0.7832]between these two groups one day after PCL LVEF was significandy higher in aspiration group than that in non-aspiration group one and nine months after PCI[(0.452±0.050) ％ vs(0.432±0.049) ％,t =3.3957,P =0.0482 ;(0.469±0.053) ％ vs (0.413±0.052)％,t =4.9457,P =0.0336].LVEDD was significantly smaller in aspiration group than that in non-aspiration group one and nine months after PCI[(49.6±5.1) mm vs(53.4±4.6) mm,t =3.4548,P =0.0473 ;(46.5±4.4) mm vs(50.2±4.8) mm,t =3.7260,P =0.0421].There were no cardiovascular events (angina,myocardial infarction,heart failure,cardiac death)in both groups during 9 months follow-up.The coronary angiography results showed that the occurrence rate of in-stent restenosis in aspiration group was significantly lower than that in non-aspiration group(2.33％ vs 6.98％,x2 =4.4351,P =0.0463).Conclusion The application of DIVER thrombus aspiration catheters during PCI in all patients with AMI was safe and effective,it can improve the myocardial tissue perfusion and the post-operative cardiac function and can lower the occurrence rate of in-stent restenosis.
ABSTRACT
Objective To compare the efficacy of thrombus aspiration catheter combined with intracoronary tirofiban and nitroglycerol injection through the aspiration catheter versus the guiding catheter during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods Thirty-four patients with STEMI undergoing primary PCI and receiving thrombus aspiration catheter combined with intracoronary tirofiban and nitroglyeerol injection through the aspiration catheter were enrolled as the aspiration group (n =34),and those who had similar coronary angiography results and basic characteristics but receiving thrombus aspiration catheter combined with intracoronary tirofiban and nitroglycerol injection through the guiding catheter were served as the guiding group ( n =33 ).The outcomes of the two groups were observed and compared.Results There was no significant change of blood pressure between before and after injection in the aspiration group ( P ＞ 0.05 ),but the change of blood pressure was significant after injection compared with before injection in the guiding group ( P ＜ 0.01 ).The cTn-I,BNP,peak-value of CK-MB,peak-time of CK-MB,TIMI grade 3 flow,slow-reflow in IRA after PCI in the aspiration group were superior to those in the guiding group ( t =3.92,P ＜ 0.01 ;t =4.70,P ＜ 0.01 ; t =3.39,P ＜ 0.01 ; t =7.17,P ＜0.01 ; x2 =3.877,P ＜ 0.05 ; x2 =3.876,P ＜ 0.05 ).LVEF,LVEDd and LVESd after 1 month in the aspiration group were superior to those in the guiding group (t =5.99,P ＜ 0.01 ;t =4.53,P ＜ 0.01 ;t =8.12,P ＜ 0.01 ),but no significant differences of LVEF,LVEDd,LVESd were found after 1 week resolution of sum of ST-segment elevation and the MACE rates after PCI were found between the two group ( P ＞ 0.05 ).Conclusion Application of thrombus aspiration catheter combined with intracoronary tirofiban injection through the aspiration catheter is more effective than through the guiding catheter in patients with Acute ST-segment elevation myocardial infarction,which could decrease slow-reflow phenomenon and improve re-perfusion and left ventricular function with better clinical outcomes.