De Luca L, Sardella G, Davidson C J, De Persio G, Beraldi M, Tommasone T, Mancone M, Nguyen B L, Agati L, Gheorghiade M, Fedele F
Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy.
Heart. 2006 Jul;92(7):951-7. doi: 10.1136/hrt.2005.074716. Epub 2005 Oct 26.
To evaluate prospectively the impact on left ventricular (LV) remodelling of an intracoronary aspiration thrombectomy device as adjunctive therapy in primary percutaneous coronary intervention (PCI) in patients with anterior ST elevation myocardial infarction (STEMI).
76 consecutive patients with anterior STEMI (65.3 (11.2) years, 48 men) were randomly assigned to intracoronary thrombectomy and stent placement (n = 38) or to conventional stenting (n = 38) of the infarct related artery. Each patient underwent transthoracic echocardiography immediately after PCI and at six months. At the time of echocardiographic control, major adverse cardiovascular events (MACE) in terms of death, new onset of myocardial infarction, and hospitalisation for heart failure were also evaluated.
After a successful primary PCI, patients in the thrombectomy group achieved a higher rate of post-procedure myocardial blush grade 3 (36.8% v 13.1%, p = 0.03) and effective ST segment resolution at 90 minutes (81.6% v 55.3%, p = 0.02). Six months after the index intervention, 19 patients (26.8%) developed LV dilatation, defined as an increase in end diastolic volume (EDV) >or= 20%: 15 in the conventional group and four in the thrombectomy group (p = 0.006). Accordingly, at six months patients treated conventionally had significantly higher end systolic volumes (82 (7.7) ml v 75.3 (4.9) ml, p < 0.0001) and EDV (152.5 (18.1) ml v 138.1 (10.7) ml, p < 0.0001) than patients treated with thrombectomy. No differences in cumulative MACE were observed (10.5% in the conventional group v 8.6% in the thrombectomy group, not significant).
Compared with conventional stenting, adjunctive aspiration thrombectomy in successful primary PCI seems to be associated with a significantly lower incidence of LV remodelling at six months in patients with anterior STEMI.
前瞻性评估冠状动脉内血栓抽吸清除装置作为辅助治疗手段，对前壁ST段抬高型心肌梗死（STEMI）患者在直接经皮冠状动脉介入治疗（PCI）中左心室（LV）重构的影响。
76例连续的前壁STEMI患者（年龄65.3（11.2）岁，48例男性）被随机分配至梗死相关动脉的冠状动脉内血栓清除及支架置入组（n = 38）或传统支架置入组（n = 38）。每位患者在PCI术后即刻及6个月时接受经胸超声心动图检查。在超声心动图检查时，还评估了主要不良心血管事件（MACE），包括死亡、新发心肌梗死及因心力衰竭住院情况。
成功进行直接PCI后，血栓清除组患者术后心肌灌注分级达到3级的比例更高（36.8%对13.1%，p = 0.03），且90分钟时ST段有效回落率更高（81.6%对55.3%，p = 0.02）。在首次干预6个月后，19例患者（26.8%）出现LV扩张，定义为舒张末期容积（EDV）增加≥20%：传统组15例，血栓清除组4例（p = 0.006）。相应地，在6个月时，接受传统治疗的患者收缩末期容积（82（7.7）ml对75.3（4.9）ml，p < 0.0001）和EDV（152.5（18.1）ml对138.1（10.7）ml，p < 0.0001）显著高于接受血栓清除治疗的患者。累积MACE未观察到差异（传统组为10.5%，血栓清除组为8.6%，无统计学意义）。
与传统支架置入相比，在前壁STEMI患者成功进行直接PCI时，辅助性血栓抽吸清除似乎与6个月时LV重构发生率显著降低相关。
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