IVUS Application Study In Patients With STEMI Emergency Interventional Diagnosis And Treatment

Objectives The purpose of this study was to evaluate the efficacy of anintravascular ultrasound (IVUS) guided strategy for emergency interventionaldiagnosis and treatment. Intravascular ultrasound was performed on the patients withemergency interventional treatment of ST segment elevation myocardial infarction(STEMI) to determine the influence of intravascular ultrasound on major adversecardiac events in patients with cardiac function in coronary blood flow, and theinfluence of the number of stents.Methods①Coronary Artery Angiography: Coronary Artery Angiography(CAG)was performed in the Judkins’s method with multi-angle and multi-positionprojection.②Percutaneous Aspiration Thrombectomy:Percutaneous Aspiration Throm-bectomy was performed with insertion of a6F PCAB3060thrombus aspirationfollowed by a guiding catheter to1~2cm at prothrombotic, connect to a30mlsyringe suction, repeated aspiration with negative pressure until thrombosis shadowdisappeared or significantly reduced.③Intravascular Ultrasound:We performedintravascular ultrasound imaging in the coronary arteries that were considered normalor diseased by Coronary Artery Angiography (CAG). The frequency of40MHz,0.5mm/s, automatic retreat, respectively plaque at the distal plaque and plaque bloodvessels at the bottom of short axis plane two-dimensional ultrasound images, IVUSdata be stored disc offline analysis and archiving.④PTCA and stent implantation:Experimental group: after the CAG and IVUS examination, According to lesioncharacteristics to choose the appropriate balloon through bellows in coronaryangioplasty (PTCA); Stent implantation, according to the characteristics of the CAGand IVUS showed lesions to choose the appropriate support.repeat the CAG andIVUS examination, evaluation stents release if the effect is not satisfied, Applicationof non compliance, balloon expansion, until conforms to the satisfaction of IVUSstandards or achieve blasting pressure after stent implantation.Control group: stents implantation, select the appropriate support based on thecharacteristics of vascular lesions, repeat the CAG, judge stents release, if the effect is not satisfied, Application of non compliance, balloon expansion, until satisfactory afterstent implantation of the CAG standards or achieve blasting pressure.⑤Observationindexes: The two groups postoperative incidences of Major adverse cardiacevents(MACE) of coronary artery intervention treatment on January, March andJune,new AMI, cardiac death and so on; Clinical Cardiac Function (NYHAclassification); EF values; The distal TIMI flow and number of stent implantation ofInfarct Related Artery(INR).Results①Experimental group:48cases with thrombus aspiration,48cases underintravascular ultrasound (IVUS)examination,4catheter could cases of PTCA. If bloodflow of infraction related artery recovered TIMI myocardial-perfusion grade of3,thepatients received intravascular ultrasound (IVUS) examination. and4cases because ofcoronary artery stenosis or circuity catheter did not pass; control group:43cases withthrombus aspiration,5cases of PTCA,5cases catheter could not pass because ofcoronary artery stenosis or circuity catheter.Patients in experimental group afterpostoperative has1case of cardiac death within1month, but the control group after1month has1case of sub-acute instent thrombosis (experimental group vs control groupχ2=0.003,p>0.05）.The two groups were compared without statistical significance.And major adverse cardiac events was not observed after postoperative3,6month intwo groups. Postoperative clinical heart function and EF values in twogroups(experimental group vs control group,1m43.6±3.0%vs44.3±5.1%;3m54.3±3.0%vs52.0±1.0%;6m54.3±3.0%vs52.0±1.0%, p>0.05), have no significantdifference after1months,3months and6months.②Experimental group: the leftanterior descending artery implanted23,circumflex artery implanted3,16in rightcoronary artery; control group:20in left anterior descending,3in circumflex branchand25in right coronary artery.Compared Two Groups stent implantationrate(experimental group vs control group,80.77%vs100%, p<0.05),the results showthat the number of patients stent significantly reduced in experimental group.Conclusions Intravascular ultrasound is a safe and efficacy strategy to performedon the patients with emergency interventional treatment of ST segment elevationmyocardial infarction (STEMI).Furthermore, stent implantation rate is low.