Evaluation Of Therapeutic Effect And Analysis Of Risk Factors Of Thrombus Aspiration In Emergency PCI Patients With High Thrombus Load STEMI

Objective:To further evaluate the clinical effect of thrombus aspiration in STEMI patients with high thrombus load and explore the risk factors of high thrombus load.It can help to effectively identify patients with high thrombus load in the early stage,better guide antithrombotic therapy,and reduce the incidence of adverse cardiac events.Methods:1.A total of 162 STEMI patients with high thrombus load who underwent emergency PCI in our hospital from January 1,2019 to March 31,2020 were selected as the research objects.According to the hospitalization order and random number,they were divided into experimental group(thrombus aspiration combined with PCI treatment,n = 91)and control group(PCI treatment,n = 71).The general information,infarct related artery(IRA),the number of diseased vessels,preoperative TIMI flow classification and thrombus load classification were recorded.TIMI blood flow classification,ST segment depression percentage(STR%),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDd)and major adverse cardiovascular events(MACE)were collected.2.A total of 218 STEMI patients who underwent emergency PCI in our hospital from January 1,2019 to March 31,2020 were selected as the research objects.According to the results of coronary angiography,they were divided into high thrombus load group(n = 132)and low thrombus load group(n = 86).The clinical data and laboratory indexes of the patients were collected and analyzed by logistic regression analysis.Results:1.there was no significant difference in general data,infarct related artery,number of diseased vessels,preoperative blood flow TIMI and thrombus load grade between the two groups.The incidence of no reflow / slow blood flow in the observation group was lower than that in the control group.The proportion of sum-STR ≥ 50% and left ventricular ejection fraction in the observation group were higher than those in the control group,while the incidence of left ventricular end-diastolic diameter and total MACE in the observation group were lower than those in the control group,and the difference was statistically significant.2.2 groups of patients are comparable in general data,past history,biochemical indexes and so on.The proportion of smokers,the level of CRP and neutrophils in the high thrombus load group were higher than those in the low thrombus load group,while the albumin level was lower than that in the low thrombus load group.Logistic regression analysis of CRP,neutrophils,low albumin level and smoking showed that CRP,OR=0.862,95%CI0.759～0.979,P=0.022 and OR=3.642,95%CI1.645～8.063,P=0.001 were independent risk factors for high thrombus load in patients with STEMI.Conclusion:1.Thrombus aspiration can improve the immediate TIMI blood flow and left ventricular diastolic function of patients with high thrombotic load STEMI,and increase the percentage of ST segment fall and left ventricular ejection fraction of the ECG 2h after surgery.2.Thrombus aspiration can improve myocardial reperfusion in patients with high thrombotic load STEMI,reduce the incidence of non-fatal myocardial infarction,target vessel reconstruction,and heart failure,but does not reduce the risk of cardiogenic death and stroke.3.CRP,low albumin level and smoking are independent risk factors for high thrombus load in patients with STEMI.