| BackgroundThe morbidity and mortality of coronary heart disease, especially acute myocardial infarction increased for the past few years. According to the world health organization report, about 8 million patients with myocardial infarction in 2010 and is expected to reach 23 million by 2030.ST-elevation myocardial infarction is characterised by plaque rupture and occlusion of the infarct artery with thrombus. The most impotant First-choice treatment is primary percutaneous coronary intervention (PCI) in order to restore infarct-related artery (IRA) patency and achieve microvascular reperfusion as early as possible, reduce the extent of myocardial infarct size. Although PCI is successful in most cases, some patients do not have complete myocardial reperfusion despite successful treatment of the culprit lesion, but a significant limitation is distal embolisation of thrombus and obstruction of the microvasculature, which it means no reflow. In STEMI, primary PCI restores macrovascular coronary blood flow effectively but microvascular perfusion remains a challenge.The pathophysiology of no-reflow is multifactorial. it is clear that abnormalities at the level of the micro vasculature cause the no reflow phenomenon and a variety of factors probably contribute to it. Some interacting mechanisms (distal embolization, ischemia-related injury,reperfusion related injury, and individual susceptibility to microvascular injury)are responsible for no-reflow phenomenon. During the PPCI the balloon-induced thrombus fragmentation and the atherothrombus under the stent struts may cause no reflow. Clinically, no-reflow is important, because of its independent association with increased in-hospital mortality, malignant arrhythmias, and cardiac failure. Aspiration thrombectomy could potentially decrease the thrombus burden at the target lesion:thus reducing distal embolization, improving final myocardial blush grade thereby improving outcomes.The first large trial was the TAPAS(N=1071) trial, which was a single center trial. Unexpectedly, mortality at 1 year was reduced in the aspiration thrombectomy group compared with the conventional PCI group. The TAP AS triai results led to routine manual thrombectomy becoming a class Ⅱa recommendation in both the American and European guidelines. The TASTE trial was a registry study randomizing patients to thrombus aspiration before PCI or PCI alone (N=7244),Which indicated that routine thrombus aspiration before PCI acompared with PCI alone did not reduce 30-day mortality among patients with STEMI.At 1-year follow-up, there was no difference in all-cause mortality, reinfarction and stent thrombosis. The TASTE trial results led to routine manual thrombectomy becoming a class Ⅱb recommendation in European guidelines.The HOTAL trial indicated that routine thrombus aspiration during PCI for STEMI did not reduce longer-term clinical outcomes and might be associated with an increase in stroke. As a result, thrombus aspiration can no longer be recommended as a routine strategy in STEMI,But many trails use the manal thrombus-aspirating device,and the rheolytic thrombectomy as compared with MTA seems to be more effective in thrombus removal and myocardial reperfusion.Among the available mechanical thrombectomy techniques, the rheolytic thrombectomy (RT) device has the potential for improved thrombus removal in acute myocardial infarction (AMI) as compared with MTA. RT is accomplished with high velocity saline jets that are contained within the distal catheter tip. The AngioJet thrombus-aspirating device is a new rheolytic thrombectomy (RT) device. There are few trails to evaluate the AngioJet thrombus-aspirating device,so we try to evaluate the clinical effectiveness of the AngioJet thrombus-aspirating device for primary percutaneous transluminal coronary intervention.Part oneObjectiveTo explore related factors indicating burden of thrombus of infarct-related arteries (IRA) in the acute phase of ST-segment elevation myocardial infarction (STEM).MethodsTwo hundred and seventy-four acute ST-segment elevation myocardial infarction (STEMI) Patients within 24 h of symptom onset were divided into two groups by angiography results.high-burden thrombus formation group (n=221) and low-burden thrombus formation group (n=63). General clinical data were collected and blood samples were collected before PCI for measurement of circulating levels of C-reactive protein (CRP) and white blood cell (WBC) count.The SPSS statistical package for Windows version 20.0 was used for the statistical analysis. Continuous variables were expressed as mean value 土 standard deviation (mean ± SD),and the comparison between groups was made using 2 independent-samples t test; Categorical variables were by number (%),the chi-square test was used to compared categorical variables; Logistic regression was used to multiplicity analysis, When P value<0.05 was considered statistically significant.ResultsThere were no significant differences in the history of diabetes, hypertension,diabetes and smoking between group (P>0.05). The high-burden group have lower systolic pressure,higher white blood cell and higher count creatine kinase muscle-brain fraction (CK-MB) (P<0.05).Using logistic regression, the age,systolic pressure,white blood cell are related to the thrombus burden.ConclusionsThe level age,systolic pressure,white blood cell are independent risk factors for high thrombus burden in STEMI.Part twoObjectiveTo evaluate the clinical effectiveness of the AngioJet thrombus-aspirating device for primary percutaneous transluminal coronary intervention(P-PCI).MethodsFrom March 2014 to July 2015,58 patients with acute ST segment elevation myocardial infarction (STEMI) treated with the AngioJet thrombus aspiration were enrolled.All patients showed angiographic evidence of high-burden coronary thrombus(thrombus score≥G3). The Thrombolysis in myocardial infarction(TIMI) flow,corrected TIMI frame count (cTFC),the thrombus score,the rate of no reflow, major adverse cardiac events during the hospital stay and the following period were investigated.ResultsThe number of patients with post-procedure TIMI flow grade of 1,2 and 3 were 1 (1.7%),2 (3.4%) and 55 (94.8%), respectively.The no reflow was occurred in 1 patient and slow flow in 2 patients after the thrombus aspiration.The cTFC was 16.4±10.4 and the thrombus score was from GO to G2 after the thrombus aspiration. Three patiens died during the hospital stay,1 patient had heart failure and 2 patiens were rehospitalized for unstable angina during the following stay.ConclusionsThe use of AngioJet device for thrombus aspiration in primary PCI is clinically safe,which can effectively lower thrombus burden in IRA,improve the sussess rate of primary PCI and reduce the incidence of no-reflow. |
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