Résumé
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.
Résumé
Objective To study the probability of evaluating myocardial tissue perfusion by corrected TIMI frame count (CTFC) after successful percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods Sixty-three patients with their first acute myocardial infarction (AMI) who accepted primary coronary intervention were recruited. All these patients got TIMI 3 grade flow. CTFC was measured after successful PCI in these patients. Wall Motion Score Index (WMSI) assessed by two-dimensional echocardiography before and one month after PCI and the correlation studied between CTFC and WMSI. Results According to CTFC the patients were divided into two groups. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group. CTFC had a significant correlation with the change in WMSI. Elapsed time from the onset of symptoms to reperfusion in the TIMI slow group was significantly longer than that of the TIMI fast group. Conclusion CTFC is a quantitative, and reproducible index of coronary blood flow. Lower CTFC is associated with greater functional recovery and could supply evidence for additional adjunctive treatment.