| Objective:To investigate the effect of thrombectomy in patients with acute ST-segment elevation myocardial infarction(STEMI)with different lesions during emergency percutaneous coronary intervention(PCI)Methods: retrospective analysis was made of 122 STEMI patients with complete coronary artery occlusion during emergency coronary angiography in our hospital from January 2013 to February 2018.Patients with thrombus still visible during emergency coronary angiography and after balloon aspiration or pre-dilation,whose blood flow did not recover after balloon aspiration or pre-dilation were divided into thrombus resection group(107 cases)and standard PCI group(15 cases)according to whether thrombus resection was performed or not.The baseline and intraoperative data,the number of corrected TIMI frames,left ventricular end-diastolic diameter(LVIDd)and left ventricular ejection fraction(LVEF)in 1 month after operation,ST-segment fall rate(STR)in 3 hours after operation and adverse cardiovascular events(MACE)in 1 year were compared between the two groups.Result:There was no significant difference in baseline data between the two groups(age P = 0.955,cholesterol P = 0.538,triglyceride P = 0.772,sex P = 0.075,hypertension P = 0.788,diabetes P = 0.788,smoking P = 0.543).During the period of PCI,there was no significant difference in the number of lesion vessels and the location of infarction-related arteries between the two groups(the number of lesion vessels P=0.915,the location of infarction-related arteries P=0.639).The corrected TIMI frame number in thrombectomy group was higher than that in standard PCI group.The left ventricular end-diastolic diameter and left ventricular ejection fraction in thrombectomy group were better than those in standard PCI group one month after operation.The difference was statistically significant(corrected TIMI frame number P=0.000,left ventricular internal diameter P=0.037,left ventricular ejection fraction P=0.005).The incidence of ST segment fall more than or equal to50%in thrombotomy group was higher than that in standard PCI group at 3 hours after operation(P=0.044).The results of one-year clinical follow-up showed that 14patients(13.1%)had primary endpoint events and 13 patients(12.1%)had secondary endpoint events within one year in the thrombectomy group.In the standard PCI group,4 patients(26.7%)had primary endpoint events and 4 patients(26.7%)had secondary endpoint events within one year.Subgroup analysis of major endpoint events showed that 6 patients(5.6%)had cardiovascular death,2patients(1.9%)had recurrent myocardial infarction,2 patients(1.9%)had cardiogenic shock and 4 patients(3.7%)had grade IV cardiac function.In standard PCI group,2 patients(13.3%)had cardiovascular death,0 patients(0%)had recurrent myocardial infarction,1 patient(6.7%)had cardiogenic shock and 1patient(6.7%)had grade IV cardiac function.Subgroup analysis of secondary endpoint events indicated that 5 cases(4.7%)had stent thrombosis and 8 cases(7.5%)had revascularization in thrombectomy group,1 case(6.7%)had stent thrombosis and 3 cases(20.0%)had revascularization in standard PCI group.There was no significant difference in the incidence of primary endpoint events between the two groups(OR=1.131,95%CI(0.581-2.203),P=0.718),and no significant difference in the incidence of secondary endpoint events(OR=0.814,95%CI(0.361-1.834),P=0.814).Conclusion:For STEMI patients whose coronary artery is completely occluded during emergency interventional therapy and is in line with the recovery of blood flow after balloon drawing or pre-dilation,but the recovery of blood flow is obvious when thrombus shadow or coronary angiography is visible,or the recovery of blood flow after balloon drawing or pre-dilation is not obvious,compared with direct PCI,thrombus aspiration can not increase significantly.Better myocardial perfusion was achieved at the risk of good cardiovascular events. |
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