在ST段升高心肌梗塞患者中"无回流现象"和高凝血的关联和预后影响
Mohamed Omar1, Min Gyu Kang2, Moon Ki Jung3
1Heart and Brain Hospital, Chung-Ang University Gwangmyeong Center, Gwangmyeong, South Korea; Cardiology Department, National Heart Institute of Egypt, Giza, Egypt.
JACC. Asia
|September 5, 2025
概括
在STEMI患者中,高血栓强度通过血栓显微镜测量,增加了穿皮冠状动脉干预后不回流现象的风险. 这一发现表明控制血栓强度可能会改善结果.
科学领域:
- 心脏病学
- 干预心脏病学
- 血液静止和血栓形成
背景情况:
- 皮肤穿刺冠状动脉干预 (PCI) 后的无反流现象与患者的治疗结果较差有关.
- 在PCI期间预防和治疗无反流仍然是一个临床挑战.
研究的目的:
- 在接受初级PCI的ST段升高心肌梗塞 (STEMI) 患者中,研究血栓发生性概况与无逆流现象之间的关联.
- 评估高血栓性和不回流的预后影响.
主要方法:
- 从现实世界注册中招募334名接受初级PCI的STEMI患者.
- 心肌梗塞中血栓溶解的评估 (TIMI) 流量等级PCI后;没有反流被定义为TIMI 0-2.
- 使用血小板纤维素凝块强度 (P-FCS) 和常规静血试验评估血小板发生率.
主要成果:
- 没有反流现象发生在11. 1%的患者中.
- 通过TEG测量的高P-FCS (≥68 mm) 与没有反流的风险显著增加相关 (OR:2. 611;P=0. 010).
- 没有反流和高P- FCS的联合存在显著增加了三年不良临床事件的风险 (aHR: 6. 654; P< 0. 001).
结论:
- 高血栓发生率,特别是高P-FCS,与STEMI中初级PCI后没有反流现象密切相关.
- 没有反流和高P-FCS的组合对不良临床事件具有附加的预后价值.
- 向凝块强度可能是减少无回流并改善STEMI患者的临床结果的策略.
相关概念视频
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
45
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
45
01:30Acute Coronary Syndrome I: Introduction
71
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
71
01:30Acute Coronary Syndrome III: Diagnostic Studies
23
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
23
01:17Ischemic Heart Disease: Overview
1.4K
Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
1.4K
01:21Myocarditis I: Introduction
28
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
28