在急性ST段升高心肌梗塞的皮革冠状动脉干预期间,远端微循环保护:随机对照试验
Gregg W Stone1, John Webb, David A Cox
1Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY 10022, USA. gs2184@columbia.edu
JAMA
|March 3, 2005
概括
在急性心肌梗塞的穿皮冠状动脉干预 (PCI) 中,远程保护有效地去除了栓塞残留物,但没有改善再输,减少心脏病发作的大小或提高生存结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 生物医学工程 生物医学工程
背景情况:
- 针对急性心肌梗塞 (AMI) 进行皮肤穿冠状动脉干预 (PCI) 的embolic事件可能导致微循环功能障碍.
- 预防微循环功能障碍可能会改善再输,减少心脏病发作的大小,并提高AMI患者的存活率.
研究的目的:
- 评估在初级PCI期间保护远端微循环免受栓塞是否能改善再输并减少心脏病发作的大小.
- 在接受PCI的STEMI患者中评估远端微循环保护系统的有效性.
主要方法:
- 一项前性随机对照试验,涉及501名患有ST段升高心肌梗塞 (STEMI) 的患者.
- 患者接受PCI与远端微循环保护系统 (气球封闭和吸收) 或标准血管造形术.
- 共同初级终点包括ST段分辨率 (STR) 和心脏病发作大小;二级终点包括主要心脏不良事件.
主要成果:
- 在大多数患者 (73%) 中,远端保护系统成功地检索了栓塞碎片.
- 两组之间没有观察到完全的ST细分分辨率 (63.3%对61.9%) 或左心室心脏病发作大小 (中位数为12.0%对9.5%) 的显著差异.
- 主要心脏不良事件在远端保护和对照组 (10.0%对11.0%) 发生的频率相似.
结论:
- 远端气球封闭和吸气系统在PCI期间有效地检索出急性STEMI的栓塞碎片.
- 尽管有效检索碎片,但远端栓塞保护并没有导致微血管流量的改善,再输血的成功,心脏病发作大小的减少或无事件生存率的提高.
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