The Investigation On Application Of Thrombus In Primary Percutaneous Coronary Intervention For Patients With St-elevation Acute Myocardial Infarction Treatment Of Acute Myocardial Infarction

Through the treatment of Thrombectomy suction by Aspiration Catheter toobserve the level of myocardial tissue and clinical outcome of patients inthrombus suction and no thrombus suction group who were undergoneemergency percutaneous coronary intervention in acute ST-segment elevationmyocardial infarction. The therapy of percutaneous coronary intervention ofSTEMI still has shorting. the shortcoming is “slow flow”or“no flow”.According to statistics, the incidence of up to about30%or so.in the event ofno-flow,it means that myocardium can not get a true sense of thereperfusion,myocardial ischemia time continue to extend.more severity ofmyocardial ischemia compared with patients with myocardial infarction of nono-reflow.risk of clinical complications increase nearly5-10times.theno-reflow is an independent predictor of left ventricular remodeling and cardiacdysfunction occurred.it is a sign of myocardial and microvascular injurytoo.patients with clinical manifestation of chest pain,arrhymia, hemodynamic,hypotension,cardiogenic shock,heart failure and even sudden death.To PCI of STEMI,application of thrombus aspiration catheter aspiration ofthrombus aspects of research results provide the inquiry with medical evidenceexample “TAPAS”trial or “EXPIRA” trial comfirmed the thrombus aspirationsuction load thrombosis reduce the occurrence of no-reflow.ordinary suctioncatheter operation is simple little damage without increasing the operation timeand surgical complexity.it’simproved patients outcomes may be relevant clearinformation about PCI treatment guideline of AHA is thrombus aspiration is reasonable for class II evidence.experiment study on this aspect are simply thePCI group and the PCI with thrombus aspiration group between the groupscontrol study.obeserved suction thrombosis group and thrombosis groupimpact on myocardial perfusion and clincal outcomes in this regard is notpumping out less.Method:221cases of acute ST-segment elevation myocardial infarctionpatients were undergone emergency PCI treatment, and according to theimaging results,we repeated the thrombus suction with suction catheter undercontinuous negative aspiration to thrombus disappeared, blood flow wasimproved.Fully attract, select the appropriate diameter of the stent according tocharacteristics of pathological changes, then pre-dilatate the pathologicalchanges with the balloon for stenting or direct stenting. According to whethersuck out the thrombus,these cases were divided into thrombosis suction groupand no thrombosis suction group, Patients were assigned to study and controlgroup randomly,each group is42patients;After the PCI,we analyzed andcompared the results of coronary angiography between the two groups,myocardial infarction experiments (thrombolysis in myocardial infarction,TIMI),blood stream classification of the TIMI myocardial perfusion (TIMIMyocardial perfusion, TMP) grade, the percentage of ECG ST-segment andclinical results ie serum creatine kinase and creatine kinase isoenzyme peak,left ventricular ejection fraction after one week of Surgery,12majorcardiovascular time.Results:1. Compared with no thrombosis suction group, the TIMI flow grade andTMP grade of thrombosis suction group were significantly improved, thedifference between the two was statistically significant (P <0.01);2. Compared with no thrombosis suction group,the percentage of ECGST-segment was lager after thrombosis suction （67.5%±28.9%vs 38.1%±30.7%，P<0.01）,;3. Compared with no thrombosis suction group,serum creatine kinase[（1278.5±69.8） U/L VS (1753.8±72.6)U/L， P<0.01]and creatine kinaseisoenzyme[(108.9±25.6)U/L VS （228.6±23.9） U/L， P<0.01] peak wassignificantly lower；4. Compared with no thrombosis suction group,left ventricular ejectionfraction was increased（56.9%±3.4%VS52.2±3.7%，P<0.01）; Left ventricularend diastolic diameter was reduced[（50.6±4.9）mm VS （55.4±4.7）mm，P<0.01];5. In no thrombosis suction group,there were2cases of no reflow,and4cases of Malignant ventricular arrhythmias and1cases of Heart failure.Conclusion:1. In acute ST-segment elevation myocardial infarction treated with PCI,the application of suction catheter to suction thrombosis is feasible and safe.2. The application of suction catheter can effectively remove intracoronarythrombus, reduce the incidence of "slow flow" or "no-reflow",improveperfusion of myocardial tissue.3. The application of suction catheter is postoperative for cardiac function,and does not increase the incidence of major cardiovascular event.4. The application of suction catheter also support that the intracoronarythrombus shedding is a reason which lead to coronary artery distalmicrocirculation thrombosis result in coronary "full flow" or "no-reflow".