A comparative analysis of direct stenting versus deferred stenting for the treatment of elderly patients with acute ST segment elevation myocardial infarction with a high thrombus load
10.3760/cma.j.issn.0254-9026.2021.10.010
- VernacularTitle:老年急性ST段抬高型心肌梗死合并高血栓负荷患者行直接支架术与延迟支架术的对比分析
- Author:
Ruifang LIU
1
;
Fangxing XU
;
Dongmei SHI
;
Yu DU
;
Qian MA
;
Yonghe GUO
;
Yujie ZHOU
;
Tongku LIU
Author Information
1. 首都医科大学附属北京安贞医院心内12病房 北京市心肺血管疾病研究所冠心病精准治疗北京市重点实验室 首都医科大学冠心病临床诊疗与研究中心 100029
- Keywords:
Myocardial infarction;
Thrombosis;
Stents
- From:
Chinese Journal of Geriatrics
2021;40(10):1265-1269
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the safety and effectiveness of direct stenting versus deferred stenting for the treatment of acute ST segment elevation myocardial infarction(STEMI)with a high thrombus load in patients aged 60 years and above.Methods:In this study, we analyzed 252 elderly STEMI patients with a high thrombus load(thrombus score ≥ 4 points)who received percutaneous coronary intervention(PCI)at Beijing Anzhen Hospital Affiliated or at the Affiliated Hospital of Beihua University from January 2015 to December 2018.They were divided into the direct stent group(n = 126)and the deferred stent group(n = 126)according to whether the stent was inserted immediately or not.Baseline information, surgical information, clinical outcomes and major adverse cardiac events were compared between the two groups at 1 year follow-up.Cox regression analysis was used to determine whether deferred stent implantation was a prognostic factor.Results:There were no significant differences in the distribution of infarct-related arteries, time from onset to balloon dilatation, thrombus load scores and the number of stents between the two groups(all P> 0.05). The diameter and length of the stent were(3.20 ± 0.47)mm and(18.33 ± 5.06)mm in the deferred stent group and(3.03 ± 0.50)mm and(22.60 ± 5.08)mm in the direct stent group, respectively, with a significant difference between the two groups( t=2.926, 6.678, P=0.004, 0.000). The incidences of slow blood flow, distal embolism and low myocardial perfusion staining in the deferred stent group were 2.38%(3/126), 3.17%(4/126)and 2.38%(3/126), respectively, significantly lower than those in the direct stent group, which were 15.87%(20/126), 24.60%(31/126)and 20.63%(26/126), respectively( χ2=13.827, 24.188, 20.614, all P=0.000). The left ventricular ejection fraction(LVEF)at 1 year in the deferred stent group was (0.60±0.05)%, significantly higher than that in the direct stent group(0.57±0.05)%( t=3.859, P=0.000). There was no significant difference in major adverse cardiac events between the two groups at 1 year follow-up( P> 0.05). Cox regression analysis results showed that deferred stent implantation was not a factor affecting the clinical outcome( HR=0.827, 95% CI: 0.288~2.372, P=0.724). Conclusions:Deferred stent implantation and direct stent intervention are equally safe and effective for STEMI patients aged over 60 with a high thrombus load if admitted to the hospital within 12 hours after onset.Deferred stent implantation can significantly improve the infarct-related artery blood flow classification, reduce the distal embolism rate, increase the grade 3 rate of myocardial perfusion staining, increase the diameter of the stent, reduce the length of the stent and improve left ventricular ejection fraction.
