Clinical Application Of EXPORT And ZEEK Aspiration Catheters In Emergency Interventions For High Thrombus Load ST Segment Elevation Myocardial Infarction

Objective:To compare the effects of two thrombus aspiration catheters,EXPORT and ZEEK,on coronary blood flow and myocardial reperfusion in patients with acute myocardial infarction with high thrombus load and on short-term clinical prognosis.Methods:101 patients diagnosed with ST-segment elevation acute myocardial infarction(STEMI)combined with high thrombus load from December 2015 to October 2019 at the Hospital were retrospectively analyzed and divided into the EXPORT group(40 patients),ZEEK group(43 patients)and control group(18 patients)according to whether thrombus aspiration and thrombus aspiration catheters were applied intraoperatively,and collected The baseline data(age,gender,BMI,coronary risk factors,killip classification at admission,creatinine,etc.),clinical characteristics(time of onset from admission,coronary lesion characteristics and surgery-related conditions),and observation indexes were intraoperative and postoperative Thrombolysis in Myocardial Infarction Clinical Trial(TIMI)classification and myocardial perfusion classification(MBG)in the three groups,and the postoperative 90 min The incidences of ST-segment regression on ECG,left ventricular ejection fraction(LVEF)at 7 days after surgery and major adverse cardiac events(MACE)at 30 days after surgery were observed.Results:In a two-by-two comparison between the three groups,1,the postoperative TIMI grade 3 flow and myocardial perfusion grade 3 ratios were higher in the EXPORT and ZEEK groups than in the control group at 92.5%and 87.5%,92.5% and 69.8%,respectively(P <0.05),and the intraoperative no-reflow/slow flow event rates were lower than in the control group at 20.0%and 32.6%,respectively 55.6%(P <0.05);In the postoperative 90 min The incidences of ST-segment regression on ECG,97.5% in EXPORT group and86.0% in ZEEK group were higher than 66.7% in control group(P < 0.05);2,myocardial perfusion in the EXPORT group was higher than that in the ZEEK catheter group 87.5% and 69.8%(P<0.05),and the incidence of intraoperative no-reflow/slow flow events was 20.0% lower than that in the ZEEK catheter group 32.6%(P<0.05);there was no difference in the proportion of postoperative TIMI flow grade 3 between the ZEEK and EXPORT groups,which were 92.5% and 90.7%(P>0.05);3,the 7-d postoperative cardiac ejection fraction was 55.638.29,56.617.54 and 50.867.62(P>0.05)and 30-d MACE incidence 4(10%),4(9.3%)and 3(16.7%)in the EXPORT and ZEEK groups and the control group,respectively(P>0.05),there was no significant difference between the three groups.Conclutions:1.Routine thrombus aspiration is not recommended in patients with STEMI undergoing direct percutaneous coronary intervention.The clinical indications of thrombus aspiration should be strictly controlled,and selective thrombus aspiration should be performed in patients with high thrombus load.2.Compared with ZEEK catheter,selective thrombus aspiration with EXPORT catheter has better blood flow and myocardial perfusion effect.Young STEMI patients with high thrombus load should give priority to thrombus aspiration with EXPORT catheter.