The Routine Application Of Aspiration Thrombectomy Catheter In Percutaneous Coronary Intervention In Patients With Acute Mocardial Infarction

Objective： To evaluate the safety and efficacy of the aspirationthrombectomy catheter during percutaneous coronary intervention(PCI) inpatients with ST segment elevation myocardial infarction(STEMI).Methods： From April2010to April2011, a total of53patients withSTEMI undergoing PCI treatment were enrolled in this study, and wererandomly divided into two groups: aspiration thrombectomy catheter groupand primary PCI group. Included ariteria of patients:(1)The patients with acuteSTEMI accord with ESC guide in2008:①persistent angina＞30min,and notalleviated by taking nitrogycerin;②ST segment elevated beyond0.1mv atleast2or more near leads;③Markers of myocardial damage(Creatime Kinase,Creatime Kinase isoemyme,troponin) were abnormal rised;(2)Patients withSTEMI attacked＜12h,or＞12h but had persistent angina;(3)Coronaryartery angiography was able to confirme the infarct related artery(IRA),flowgrade was0-Ⅰgrade,and IRA was treated by PCI;(4)The diameter of IRA≥2.75mm,and located at near-middle artery;(5)None contraindication ofantiplatelet and anticoagulation.Exclude ariteria:(1)Patients were allergic todrugs;(2)Specific history of MI,PCI or CABG;(3)Patients attended by heartdisfuntion or cardiogenic shoch(Killip≥Ⅲ);(4)The function of liver andkidney injured(aminopherase≥120U/L,creatinine≥176.8μmol/L).All patientswere undergone standard CAG to identify IRA and stents were implanted toIRA,the catheter group applicated aspiration thrombectomy catheter.Then wecompared TIMI flow grade,corrected TIMI frame count (cTFC), myocardialblush grade (MBG), the rate of no reflow, ST segments resolution2h, CK-MBpeak serum time, left ventricular ejection fraction (LVEF), left ventricularend-diastolic diameter (LVEDD) post PCI, major adverse cardial events (MACE)(including death, repeate MI, repeate revascularization and so on).Follow-up period was6months.Date were statistically analyed with use ofSPSS13.0,continuous variables are presented as mean±standarddeviation,and categorical are presented as percentile.Date were compared by ttest or chi-squared test.A two-tailed P＜0.05was considered as statisticallysignificant.Results: The general materials of age,sex,hypertension,diabetes,hyperlipidemia,infarct related artery,the time of attacking to be hospitalized,the type of stent,the number of stent,the diameter of stent,the length of stent,the time of opertion,the successful rate of PCI were unsignificance betweenthe two groups(P＞0.05).The rate of no reflow, the time of CK-MB peak valueafter PCI and LVEDD were lower in aspiration thrombectomy catheter groupthan standard percutaneous coronary intervention group (3.84%vs14.81%,8.42±2.76vs13.58±3.48,46.16±4.28vs55.78±5.48, P＜0.05)；TheTIMI flow grade, corrected TIMI frame count (cTFC), myocardial blush grade(MBG),ST segments resolution2h, the time of CK-MB peak time, leftventricular ejection fraction (LVEF) were significantly improved in aspirationthrombectomy catheter grou(p76.92%vs62.96%,28.35±11.59vs39.65±12.39,2.78±0.53vs2.25±0.56,68.69±1.62vs45.54±1.76,65.48±6.52vs57.43±8.47,P＜0.05)；The incidenceof MACE were similar between the two groups inhospitalization(P＞0.05).After6months, LVDED were lower in aspirationthrombectomy catheter group than standard percutaneous coronaryintervention group (44.32±3.91vs53.64±4.36, P＜0.05), LVEF weresignificantly improved in aspiration thrombectomy catheter group(69.04±5.98vs60.79±7.92,P＜0.05), The incidence of MACE after6months follow-upwere similar between the two groups (P＞0.05).Conclusion: In AMI patients treated with primary PCI, application ofaspiration thrombectomy catheter was safe and effective, which could lowerthe rate of no reflow, increase distal myocardium perfusion, improvemyocardial remodeling,enhance cardial function,and improve patient's recentoutcome.