高旸 杨继娥 张峰

摘 要 急性心肌梗死患者接受直接经皮冠状动脉介入治疗植入支架后的微血管栓塞和无复流现象一直是影响患者预后的主要因素之一。延迟支架植入是降低支架植入后微血管阻塞和无复流风险的方法之一，其与强化抗血栓药物治疗相结合，能减轻急性心肌梗死患者的血栓负荷，降低短期血管造影检查事件的发生率。然而，多项随机、对照研究和荟萃分析都未能证实该方法对急性心肌梗死患者的长期死亡率、主要心血管不良事件发生率和其他临床终点有改善作用，因此临床上对延迟支架植入是否有益还存在争议。延迟支架植入的应用也受到新一代药物洗脱支架得到广泛应用的限制，需有更多的临床研究证实延迟支架植入在特殊的急性心肌梗死患者亚群中的安全性和有效性。

关键词 急性心肌梗死 直接经皮冠状动脉介入治疗 延迟支架植入

中图分类号：R542.22； R654.3 文献标志码：A 文章编号：1006-1533（2019）01-0008-04

Deferred stent implantation for acute myocardial infarction： a review of recent studies

GAO Yang*， YANG Jie*， ZHANG Feng**

（Department of Cardiology， Zhongshan Hospital， Fudan University， Shanghai 200032， China）

ABSTRACT Microvascular obstruction and no-reflow after stent implantation in patients presenting with acute myocardial infarction and undergoing primary percutaneous coronary intervention are strong predicting factors of adverse events and unfavorable prognosis， especially when it comes to patients with greater age， longer occlusion or strong thrombus burden. To deal with this situation， some specialists come up with a deferred stent implantation method. Deferred stent implantation with adjunctive antithrombotic therapy is an effective method to alleviate the thrombus burden， partially restore vascular function and reduce the risks of microvascular obstruction， no-reflow phenomena and short-term angiographic events. However， several randomized controlled trials and related meta-analysis indicate that deferred stent implantation did not reduce mortality， major adverse cardiac events or other severe clinical outcome. The advantage of deferred stent implantation is in controversy and its application is limited due to the widespread usage of second-generation drug-eluting stents. More clinical trials are necessary to confirmed the effect and safety of deferred stent implantation on specific subgroup of patients with acute myocardial infarction.

KEy WORDS acute myocardial infarction； primary percutaneous coronary intervention； deferred stent implantation

在急性心肌梗死的直接经皮冠状动脉介入治疗（primary percutaneous coronary intervention， PPCI）中，成功恢复血流后植入支架已成为常规治疗方法。支架能有效防止术后早期血管的急性闭塞和夹层的发生，增大管腔体积，确保有更理想的血流灌注。然而，急性心肌梗死患者中有相当一部分会在植入支架后发生远端栓塞和微血管阻塞[1]，严重的甚至出现无复流现象，导致更大的梗死范围和更高的患者死亡率[2-3]。尽管采用血栓抽吸和远端保护装置能降低远端栓塞的风险，但却没有患者预后改善作用[4-6]。……