直接经皮冠状动脉介入治疗术中血栓抽吸联合山莨菪碱预防无复流的研究

目的：本研究旨在评价急性心肌梗死直接经皮冠状动脉介入治疗术（PCI）中血栓抽吸导管联合山莨菪碱预防无复流的作用。方法：连续人选初始血管造影TIMI血流≤2级行直接经皮冠状动脉介入的ST段抬高型心肌梗死患者，随机分配到A组（经血栓抽吸导管先注射1000p-g固定剂量的山莨菪碱，然后注射替罗非班10μg／kg）和B组（经血栓抽吸导管注射替罗非班10μg／kg），两组患者均以0．15μg·kg-1·min。连续泵人替罗非班36h。主要终点为术后校正TIMI计帧数（cTFC）、心肌呈色分级（MBG）、完全ST段回落率（STR）。二终点包括血流分级（TIMI）、CK—MB峰值、6个月随访的主要心血管不良事件（MACE，靶血管重建、再次心梗、心源性死亡）和左室射血分数（LVEF）。结果：累计入选病例143例，A组72例，B组71例。两组之间的基本临床情况和血管造影特征无明显差异。与B组比较，A组：①术后cTFC水平明显低（P〈0．01）；②STR明显高（P〈0．05）；③MBG2～3级比例较高（P〈0．05）；④CK—MB峰值明显低于B组（P〈0．05）；⑤随访6个月LVEF水平明显高于B组（P〈o．01）；⑥PCI术后两组之间TIMI3级血流比例无明显差异。胸痛到PCI时间、门一球囊扩张时间、支架直径、支架长度均无明显差异。A组6个月的MACE事件发病率显示出降低趋势，但是差异无统计学意义。结论：直接经皮冠状动脉介入治疗术中经血栓抽吸导管注射山莨菪碱不仅改善心肌水平灌注、减少心梗面积，并改善术后心室收缩功能。

Impact of thrombus aspiration conjugative with anisodamine for the prevention of no-reflow phenomenon following primary percutaneous coronary intervention

Objective：We sought to evaluate the combination therapy of thrombus aspiration plus anisodamine in prevention of no-reflow phenomenon during pereutaneous coronary intervention. Method：From October 2009 to June 2012,143 consecutive patients with STEMI who received manual thrombus aspiration were involved in a double center prospectively analysis. The patients were treated with anisodamine （1 000μg/kg） plus tirofiban （10 μg/kg）（group A,n=72） and tirofiban （10μg/kg） alone （group B,n=71） ,respectively. The drugs were selectively injected into the infarct-related artery （IRA）, through the occlusion to the distal segment via the thrombus aspiration catheter advanced into the IRA. Primary endpoints were postprocedural corrected thromholysis in myocardial infarction frame count （cTFC）. The proportion of complete （〉 70 % ） ST-segment resolution （STR）, myocardial blush grade 2 - 3 （MBG）post PCI. Secondary endpoints included peak value of creatine kinase-MB; TIMI flow grade;6-month outcome including left ventricular ejection fraction （LVEF）, as well as cardiac death, target vascular revascularization,re-infarction and their combination as major adverse cardiac events （MACE）. Result： Baseline characteristics were not different between the two groups. Compared to group B,group A had ① a lower corrected TIMI coronary flame count （P〈0.01）, ② a higher proportion of complete ST-segment resolution （P〈 0. 05）.③ a better myocardial blush 2-- 3 grade ratio （P = 0.05）, and ④ a lower peak creatine kinase MB （P〈 0. 05 ）, There was no differences in TIMI 3 flow grade between the two groups （P〈0.05）. No differences were found in cardiac death, TVR, re-infarction, MACE, between the two groups during 6-month follow-up, only an improvement trend in group A（P〈0.05）. Nevertheless,The LVEF at 6 month was higher in group A （P〈0.01）. Conclusion： Preventively intracoronary administration of anisodamine 1000 ug via the thrombus aspiration catheter can improve myocardial reperfusion for acute STEMI with initial TIMId2 treated with primary PCI.