Дата: 2009-06-02 22:01
????????? ??????????? ?????? ?? ????? ????????? ????????????? ???????? ? ????????????? ???????????? ???????. ?????? ????????? TAPAS.
02.07.08
? ??????? ?????????????? ????????? TAPAS* ???? ?????????????????? ????????????? ?????? ????????? ?????? ?? ????? ?????????? ??????????? ??????????? ????????????? (???) ? ????????? ????????? ???????? ? ???????? ???????? ST (???ST) ? ????????? ?????????? ?????????? ????????. ??????, ??????????? ????????????, ????????? ?????? ??????????????? ????????? ???????? ????? ??? ?????? ???????????? ??????????? ????????????? ??????? ?????????????.
?????? ? ??? ????????????.
???????????? ????????? ?????? ?? ????? ?????????? ?????????? ??????????? ??? ?????? ???????? ???????? (Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study; TAPAS) ???? ????????? ? ??????????????? ??????????? ?????? ?????????? (??????????) ??? ????????????? ????????????????? ???????? ????????? ? ??????????? ??????? ???????? ?????. ? ???????????? ??? ??????? 1071 ??????? ? ?????????? ???ST ?? 30 ????? ?? 12 ?????. ??????????? ???????, ???????????? ??? ????????????? ??? ????? ???????????????? ???????, ? ? ?????????????? ?????????????????? ????? ????? 6 ???????.
?? ?????????? ?????????????? ????????? ????????????????? ? ?????? ??? ? ?????????? ?????? (n=535) ? ??????? ???????? Export Aspiration Catheter (Medtronic Corporation, ???) ? ? ?????? ????????????? ??? (n=536). ?????????????? ????? ??? ???????? ?? ??????????? ??? ???????? (500 ??), ???????? (5000 ??) ? ???????????? (600 ??). ??? ?????????? ???????????????? ??????? ????? ???????? ?????????? ? ?????????????? ????? ???????? ?? ??????????? ??????????? ??????????????? ??????? ??????????? ?????. ??????????? ??????? ????? ??? ???????? ??????? ? ???????????? ? ?????????????? ???????? ????? 80–100 ?? ? 75 ?? ??????????????, β-????????, ?????????????? ????????, ????????? ???????????????????????? ???????? ??? ???????? ?????????? ???????????? II.
????????? ???????? ?????? ???????????? ???? ??????? ??????????????? ???????? (myocardial blush) ??? ????????? ????????? ??????? 0–1 ????? ???*. ????????? ???????? ????? ???????? ??????? ?????????? ??????????? ????????? ??????? 3 ?? ????? TIMI, ??????? ??????????? ???????? ST ? ????????, ?????????? ???????? ???????? ???????? ST, ??????? ???????? ??????????????? ????????? ??????? ? ??????? 30 ????? ? 1 ???? ????? ???.
??????????.
??????????? ?????? ? ??????? 1 ???? ???? ?????????? ? 530 ????????? (99,1%) ?????? ????????? ?????? ? ? 530 ??????? (98,9%) ?????? ????????????? ???. ?? ??? ????? ?????? 66 ?????????? ?????????, ? ??? ????? 55 (83,3%) ?? ????????? ???????: ?? ??? 30 – ? ?????? 30 ????? ? 25 – ?? 30 ????? ?? 1 ????. ?????????? ?? ????????? ??????? ????????? ? ?????? ????????? ?????? 3,6% (19 ???????) ?????? 6,7% (36 ???????) ? ?????? ????????????? ??? (????????? ?????? [??] – 1,93; 95% ????????????? ???????? [??] 1,11–3,37; ?=0,02), ??????? ?????????? ?? – 2,2% (12 ???????) ?????? 4,3% (23 ??????) ?????????????? (?? – 1,97; 95% ?? 0,98–3,96; ?=0,05), ?????????? ?????? ?? ????????? ??????? ? ?? – 5,6% ?????? 9,9% ?????????????? (?? – 1,81; 95% ?? 1,16–2,84; ?=0,009). ????? ?????????? ? ??????? 1 ???? ????? ????????? ???? ??? ??? ? ?????????? ??????: 4,7% ?????? 7,6% ? ?????? ????????????? ??? (?? – 1,67; 95% ?? 1,02–2,75; ?=0,042).
??????? ??????????????? ???????? ????????? ????? ??? ???? ?????????? ??????? ? ???????????? ???????? ? ??????? 1 ????: ? ????? ??????????? (3,7% ??? 3 ???????, 4,7% ??? 2 ???????, 11,0% ??? 0–1 ???????; ?=0,001), ?? ??????????? ?? ????????? ??????? (2,4%, 4,4% ? 8,5% ??????????????; ?=0,003) ? ? ??????????? ????????? ? ????????? ?? (4,7%, 7,3% ? 12,2% ??????????????; ?=0,004). ??????? ???????????? ??????????? ???????? ST ? ???????? ????? ??? ????? ?????????????? ??????? ?????????? ????????: ??? ???????? ST >70%, ?? 30 ?? 70% ? <30% ?? ????????? ????? ?????????? ????????? 2,6%, 6,0% ? 16,8% ??????????????, ?????????? ?? ????????? ??????? – 1,4%, 5,6% ? 15,3%, ? ?????????? ?????? ?? ????????? ??????? ? ?? – 2,8%, 9,5% ? 20,0% ?????????????? (??? ?<0,0001).
??? ?????????????? ??????? ???????????? ???????????? ????? ?????? ?? ????????? ??????? ? ?????????? ?? ????????? ????????? ?????? ?? ????? ??? (????????? ?????? [??] – 0,54; ?=0,025), ??????? (?? – 1,04; ?=0,001), ???????? ?????? (?? – 3,22; ?<0,0001) ? ??????? ????? ?????? ??? ??????????? (?? – 1,02; ?=0,027).
??????.
? ????????? TAPAS ??????? ????????, ??? ? ????????? ???ST ????????? ????????? ??????????? ?????? ????? ????????? ??? ?? ?????????????? ?? ?????? ???????? ? ????????? ???????? ???????? ????? ????? ????????, ?? ? ?????????????? ??????? ??????????? ???????????? ???????????? ? ????????? ? ???????????? ????????????.
????????.
Vlaar P.J., Svilaas T., van der Horst I.C. et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. June 7, 2008; 371: 1915–20

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