分析急性心肌梗塞病人,行緊急心導管治療時，使用AngioJet行血栓移除術對心肌血流灌注及病人六個月存活率的影響

張永明

doi:10.6834/CSMU.2012.00047

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分析急性心肌梗塞病人,行緊急心導管治療時，使用AngioJet行血栓移除術對心肌血流灌注及病人六個月存活率的影響

Analysis of AngioJet Thrombectomy on Myocardial Perfusion and Six-month Survival for Patients with Acute ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

張永明 , Masters　　Advisor：林中生;林志立　　

繁體中文 DOI： 10.6834/CSMU.2012.00047

急性心肌梗塞； AngioJet血栓清除術； MBG血流； Acute ST-elevation myocardial infarction ； AngioJet thrombectomy ； myocardial blush grade ( MBG )

Abstract │ Reference (23) │ Altmetrics

Abstract 〈TOP〉

Parallel Abstract 〈TOP〉

Objective: Patients with acute ST-elevation myocardial infarction may have persistent impairment of microvascular blood flow even after successful primary percutaneous coronary intervention ( PCI ). Distal embolization is a possible mechanism of microvascular dysfunction and impaired myocardial perfusion. There has been increasing interest in adjunctive mechanical thrombectomy to improve outcomes in primary PCI. The aim of the present report is to study the role of AngioJet thrombectomy in primary PCI for acute ST-elevation myocardial infarction .

Method and Materials: This is a retrospective cohort study. Patients presented with acute ST-elevation myocardial infarction and received primary PCI in ChangHua Christian Hospital between Jan. 2003 and Oct. 2007 were enrolled. Totally 313 patients were included, 219 patients are in the AngioJet group and the other 94 patients are in the control group. The baseline characteristics, angiographic findings and 6-months survival in these two groups were recorded.

Results: Patients in the AngioJet group have more male, cardiac enzymes elevation and angiographically visible thrombus. The angiographic findings showed that 94.1%  in the AngioJet group have TIMI 3 flow after primary PCI, but only 80.9% in the control group have the same TIMI 3 flow. Besides, we also find the similar MBG flow between two groups. MBG 3 flow was achieved in 56.2% of the AngioJet group and 39% of the control group. The 6-months survival did not show significant difference between groups ( 93.2% versus 91.5% ).

Conclusion and Suggestion: AngioJet thrombectomy in primary PCI for patients with acute ST-elevation MI can improve TIMI flow and MBG flow. But it remains to be established weather the device improves outcomes. The current evidence does not support the routine use of the AngioJet system in primary PCI. But in selected patients with large burden of thrombus, it still can provide clinical benefit as an adjunct to primary PCI.

Reference ( 23 ) 〈TOP〉

[1] Lambert L, Brown K, Segal E, et al. Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction. JAMA 2010;303:2148-55.
連結：
[2] Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet 2003;361:13-20.
連結：
[3] Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 2000;283:2941-7.
連結：
[4] Saif SR, Jeptha PC, Jersey C, et al. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ 2009;338:b1807.
連結：
[5] Francesco B, Maria DV, Youlan LG, et al. Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. Eur Heart J. 2009;30,2193-2203.
連結：

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