Kaltoft Anne, Bøttcher Morten, Nielsen Søren Steen, Hansen Hans-Henrik Tilsted, Terkelsen Christian, Maeng Michael, Kristensen Jens, Thuesen Leif, Krusell Lars Romer, Kristensen Steen Dalby, Andersen Henning Rud, Lassen Jens Flensted, Rasmussen Klaus, Rehling Michael, Nielsen Torsten Toftegaard, Bøtker Hans Erik
Department of Cardiology B, Aarhus University Hospital, Skejby, 8200 Aarhus N, Denmark.
Circulation. 2006 Jul 4;114(1):40-7. doi: 10.1161/CIRCULATIONAHA.105.595660. Epub 2006 Jun 26.
Distal embolization during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction may result in reduced myocardial perfusion, infarct extension, and impaired prognosis.
In a prospective randomized trial, we studied the effect of routine thrombectomy in 215 patients with ST-segment-elevation myocardial infarction lasting <12 hours undergoing primary PCI. Patients were randomized to thrombectomy pretreatment or standard PCI. The primary end point was myocardial salvage measured by sestamibi SPECT, calculated as the difference between area at risk and final infarct size determined after 30 days (percent). Secondary end points included final infarct size, ST-segment resolution, and troponin T release. Baseline variables, including ST-segment elevation and area at risk, were similar. Salvage was not statistically different in the thrombectomy and control groups (median, 13% [interquartile range, 9% to 21%] and 18% [interquartile range, 7% to 25%]; P=0.12), but 24 patients in the thrombectomy group and 12 patients in the control group did not have an early SPECT scan, mainly because of poor general or cardiac condition (P=0.04). In the thrombectomy group, final infarct size was increased (median, 15%; [interquartile range, 4% to 25%] versus 8% [interquartile range, 2% to 18%]; P=0.004).
Thrombectomy performed as routine therapy in primary PCI for ST-elevation myocardial infarction does not increase myocardial salvage. The study suggests a possible deleterious effect of thrombectomy, resulting in an increased final infarct size, and does not support the use of thrombectomy in unselected primary PCI patients.
ST段抬高型心肌梗死患者在进行直接经皮冠状动脉介入治疗（PCI）时发生远端栓塞，可能会导致心肌灌注减少、梗死范围扩大及预后不良。
在一项前瞻性随机试验中，我们研究了215例发病时间小于12小时且接受直接PCI的ST段抬高型心肌梗死患者接受常规血栓切除术的效果。患者被随机分为血栓切除术预处理组或标准PCI组。主要终点是通过锝-99m甲氧基异丁基异腈单光子发射计算机断层显像（Sestamibi SPECT）测量的心肌挽救率，计算方法为风险区域与30天后确定的最终梗死面积之差（百分比）。次要终点包括最终梗死面积、ST段回落及肌钙蛋白T释放情况。包括ST段抬高及风险区域在内的基线变量相似。血栓切除术组和对照组的心肌挽救率无统计学差异（中位数分别为13%[四分位间距，9%至21%]和18%[四分位间距，7%至25%]；P = 0.12），但血栓切除术组有24例患者和对照组有12例患者未进行早期SPECT扫描，主要原因是全身状况或心脏状况较差（P = 0.04）。在血栓切除术组，最终梗死面积增大（中位数为15%；[四分位间距，4%至25%]，而对照组为8%[四分位间距，2%至18%]；P = 0.004）。
在ST段抬高型心肌梗死直接PCI中作为常规治疗进行的血栓切除术并不会增加心肌挽救率。该研究提示血栓切除术可能存在有害作用，导致最终梗死面积增大，不支持在未经筛选的直接PCI患者中使用血栓切除术。
