De Rosa Salvatore, Cirillo Plinio, De Luca Giuseppe, Galasso Gennaro, Esposito Giovanni, Leosco Dario, Piscione Federico, Chiariello Massimo
Division of Cardiology, University of Naples Federico II, Naples, Italy.
J Interv Cardiol. 2007 Aug;20(4):292-8. doi: 10.1111/j.1540-8183.2007.00271.x.
Aim of the present study was to compare the immediate and long-term effects of AngioJet rheolytic thrombectomy performed in the setting of a percutaneous coronary angioplasty (PTCA) with those of conventional PTCA in patients with acute myocardial infarction (AMI) and angiographic evidence of high intracoronary thrombus burden.
Plaque rupture, with subsequent exposure to the flowing bloodstream of high thrombotic materials often leads to intravascular thrombosis, representing the main pathophysiological event of acute coronary syndromes. PTCA is the first-choice treatment for these patients in hospitals with cardiac catheterization facilities. However, distal embolization of thrombotic material, fibrin, and other fragments from atherosclerotic plaques might lead to procedural failure.
Immediate and 1-year follow-up results of a group of 30 consecutive patients, presenting with AMI and angiographic evidence of high thrombus burden, who underwent rheolytic thrombectomy and PTCA were compared with those of 30 consecutive patients with similar clinical presentation, risk profile, and angiographic picture, and treated with standard PTCA procedure.
After the procedure, angiographic analysis showed a higher incidence of final thrombolysis in myocardial infarction (TIMI) flow grade 3 in the AngioJet group (93.3% vs 83.3%, P = 0.034). In addition, mean corrected TIMI frame count (cTFC) was significantly lower in the AngioJet group (22.4 vs 32.4, P = 0,0004). At 1-year follow-up, patients treated with AngioJet showed a significantly lower incidence of death (3.33% vs 13.33%,P < 0.001), major adverse cardiac events (MACE: 10% vs 30%, P = 0.026), and need of revascularization (6.67% vs 20%, P = 0.013).
Data of the present study highlight that AngioJet thrombectomy in selected AMI patients at high risk for distal thrombotic embolization results not only in immediately improved angiographic results as compared to conventional PTCA but, indeed, seems to be associated with a significantly better long-term clinical outcome.
本研究旨在比较在经皮冠状动脉成形术（PTCA）背景下对急性心肌梗死（AMI）且冠状动脉内血栓负荷高有血管造影证据的患者进行AngioJet机械血栓切除术的即刻和长期效果与传统PTCA的效果。
斑块破裂，随后暴露于富含高血栓形成物质的流动血流中，常导致血管内血栓形成，这是急性冠状动脉综合征的主要病理生理事件。在有心脏导管设备的医院，PTCA是这些患者的首选治疗方法。然而，来自动脉粥样硬化斑块的血栓物质、纤维蛋白和其他碎片的远端栓塞可能导致手术失败。
将一组30例连续的表现为AMI且有高血栓负荷血管造影证据并接受了血栓溶解切除术和PTCA的患者的即刻和1年随访结果，与30例具有相似临床表现、风险概况和血管造影图像并接受标准PTCA手术的连续患者的结果进行比较。
手术后，血管造影分析显示AngioJet组心肌梗死溶栓后血流分级（TIMI）3级的发生率更高（93.3%对83.3%，P = 0.034）。此外，AngioJet组的平均校正TIMI帧数（cTFC）显著更低（22.4对32.4，P = 0.0004）。在1年随访时，接受AngioJet治疗的患者死亡发生率显著更低（3.33%对13.33%，P < 0.001），主要不良心脏事件（MACE：分别为10%和30%，P = 0.026），以及血运重建需求（6.67%对20%，P = 0.013）。
本研究数据表明，在有远端血栓栓塞高风险的特定AMI患者中，AngioJet血栓切除术不仅与传统PTCA相比能即刻改善血管造影结果，而且似乎与显著更好的长期临床结局相关。
