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Effect of distal protection device on prognosis of acute myocardial infarction combined with emergency percutaneous coronary intervention

要英杰  邵一兵  王旭  
【摘要】:Background The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes.Also the application of thrombolytic agent inside of coronary artery,platelet inhibitors GPⅡ/Ⅲ or direct thrombectomy can't improve short or long-term clinical outcomes,So we evaluated the safety and efficacy of distal protection device(GuardWire PlusTM)in the acute myocardial infarction(AMI)combined with percutaneous coronary intervention(PCI).Method Seventy-two patients with acute myocardial infarction receiving emergency PCI were randomly assigned into the distal protection group(GW group)and non-distal protection group(NGW)group.Data analyzed between the two groups were included the clinical characteristics,angiographic results,ST segment resolution,postoperative TIMI flow grade,TIMI frame count,myocardial blush grade,the left ventricular ejection fraction(LVEF)by echocardiography in a week after or 3 months after PCI,myocardial enzymes,preoperative and postoperative neuroendocrine biomarkers:endothelin(ET),plasma renin activity(PRA),angiotensin II(AII),aldosterone(ALD),norepinephrine(NE),epinephrine(E).Results ST segment resolution ≥ 50% was significantly higher in the GW group(68.4%)than in NGW group(41.2%,P 0.05).Early peak CK-MB and CTNI in GW group versus NGW group(8.63 ± 2.42 hours vs 11.18 ± 2.26 hours,10.16 ± 2.96 hours vs 12.35 ± 2.06 hours),and peak reduction difference were observed(63.3 ± 9.82 vs 74.28 ± 6.15 P = 0.000,18.01 ± 7.21 vs 21.48 ± 5.61 P = 0.027).Left ventricular ejection fraction(LVEF)was higher in GW group(P = 0.01)than in NGW group.TIMI grade exhibited no difference while TIMI frame count(P = 0.043)and myocardial blush grade were significantly different(P = 0.0001).Postoperative biomarkers in endocrine expression were higher significantly in NGR group(P 0.05).Conclusions Emergency PCI combined with distal protection device can help prevent distal embolism,reduce the risk of no-reflow and slow flow and thereafter improve the prognosis in AMI patients.[S Chin J Cardiol 2011;12(3):165-171]

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