For patients with hyperthrombotic burden acute myocardial infarction who undergo direct percutaneous coronary intervention (PCI), Pan Hongwei, Liu Jinwu, etc. of the Hunan Heart Failure Clinical Medical Research Center found that thrombotic aspiration combined with intracoronary thrombolysis can better improve coronary microcirculation disorders in patients.
study showed that patients who received thrombotic aspiration combined with intracoronary thrombolysis were lower than those who received simple aspiration, based on quantitative blood flow fractions and corrected TIMI frame count (CTFC).
Moreover, the ST segment drop rate of the 1 hour post-PCI surgery, the proportion of patients with TIMI myocardial perfusion grade (TMPG) grade 3, myocardial perfusion development grade (MBG) grade 3, and TIMI blood flow grade 3 after surgery were higher than those who received simple aspiration.
This suggests that the combination treatment method can help reduce the microcirculation resistance of the blood vessels of criminals with high thrombosis burden, and can better improve coronary microcirculation disorder caused by myocardial infarction.
Moreover, the ST segment of the electrocardiogram in patients who received thrombosis aspiration combined with intracoronary thrombolysis decreased significantly by a large 1 hour postoperative period, which suggests that this combination therapy has achieved better myocardial perfusion level.
researchers also compared the effects of different orders of aspiration and thrombolysis. The results showed that the AMR and CTFC of patients who aspirated first and then thrombolysis were lower than those who had thrombolysis first and then aspirated, and the proportion of patients with TIMI level 3 blood flow after surgery was also higher.
Researchers pointed out that thrombolytic drugs can gradually exert the role of thrombolytic, thereby causing the ischemic myocardium to form "gradual reperfusion". In theory, it can effectively avoid sharp changes in the environment of ischemic myocardium during reperfusion, reduce the occurrence of reperfusion injury, and reduce the area of myocardium necrosis.
The reason why thrombolysis is better after first aspiration may be because thrombotherapy removes the general thromboplasm in the criminal's blood vessels. Local intracoronary injection of thrombolysis drugs can achieve higher drug concentrations at the site of thrombogenesis with a smaller dose of drug. By weakening the fibrin structure, residual thromboplasm and intraoperative shedding may cause distant embolization of , so that microthrombus clearance is more thorough, reducing slow blood flow and no reflux occurs, and improving the effect of microcirculation perfusion.
This study included 1351 patients with ST-segment elevation myocardial infarction. According to the treatment of hyperthrombotic load on the criminals, the patients were divided into coronary artery simple thrombus aspiration group (n=938) and thrombus aspiration combined with coronary thrombolytic group (n=413); the combined treatment groups were also divided into thrombolytic subgroup first and then aspiration subgroup (n=102) and thrombolytic subgroup first and then aspiration subgroup (n=311). Afterwards, the researchers used the 1:2 propensity matching method for analysis.
Source: Liu Jinwu, Rong Jingjing, Liu Zhengyu, et al. Effects of thrombosis and intracoronary thrombolysis on coronary microcirculation after direct percutaneous coronary intervention treatment in patients with acute ST segment elevation myocardial infarction in . Chinese Journal of Circulation , 2022, 37: 1097-1104. DOI: 10.3969/j.issn.1000-3614.2022.11.004. [ Long press or scan the QR code to see the original text ]
Reprinted: Please indicate "Chinese Journal of Circulation"
