Sardella Gennaro, Mancone Massimo, Nguyen Bich Lien, De Luca Leonardo, Di Roma Angelo, Colantonio Riccardo, Petrolini Alessandro, Conti Giulia, Fedele Francesco
Department of Cardiovascular, Respiratory, and Morphologic Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy.
Catheter Cardiovasc Interv. 2008 Jan 1;71(1):84-91. doi: 10.1002/ccd.21312.
In patients with ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) may cause thrombus dislodgment leading to microvascular function impairment, which is a negative independent predictor of myocardial function recovery. Compared with conventional stenting, pretreatment with aspiration thrombectomy during primary PCI significantly improves coronary epicardial flow and myocardial tissue perfusion parameters. We sought to evaluate the angiographic findings of two different manual aspiration thrombectomy devices (Diver-Invatec (DI) and Export-Medtronic (EM)) in STEMI patients undergoing primary angioplasty.
We randomized 103 STEMI patients referred to our hospital to undergo primary PCI (<12 hr from symptoms onset) to DI (n = 52) and EM (n = 51) devices. The primary angiographic composite end-points were the rates of post-thrombectomy thrombus score (TS) < or =2, TIMI flow grade > or =2, and post-stenting myocardial blush grade (MBG) > or =2 in the two groups.
Baseline, clinical, and angiographic preprocedural findings did not differ between the two groups. After aspiration thrombectomy, a TS < or = 2 was more frequently present in EM group (92.3 vs. 69.3%, P = 0.0052). Also the rate of post-thrombectomy TIMI > or = 2 (69.3 vs. 92.2%, P = 0.0052) and post-stenting MBG > or =2 (88.2 vs. 69.3%, P = 0.029) were significantly higher in EM group. No significative differences were observed in terms of clinical events at 1 and 12 months.
In this single-center, prospective, randomized study, a EM use before stenting in STEMI patients seems to remove more thrombotic burden compared with DI, providing a greater post-thrombectomy epicardial flow and a better post-stenting microvascular perfusion.
在ST段抬高型心肌梗死（STEMI）患者中，直接经皮冠状动脉介入治疗（PCI）可能导致血栓脱落，进而引起微血管功能损害，这是心肌功能恢复的一项独立负面预测因素。与传统支架置入术相比，在直接PCI期间先行血栓抽吸术预处理可显著改善冠状动脉心外膜血流和心肌组织灌注参数。我们旨在评估两种不同的手动血栓抽吸装置（Diver-Invatec（DI）和Export-Medtronic（EM））在接受直接血管成形术的STEMI患者中的血管造影结果。
我们将103例转诊至我院接受直接PCI（症状发作后<12小时）的STEMI患者随机分为DI组（n = 52）和EM组（n = 51）。主要血管造影复合终点是两组血栓抽吸术后血栓评分（TS）≤2、心肌梗死溶栓试验（TIMI）血流分级≥2以及支架置入后心肌灌注分级（MBG）≥2的发生率。
两组之间的基线、临床和血管造影术前结果无差异。血栓抽吸术后，EM组更常出现TS≤2（92.3%对69.3%，P = 0.0052）。此外，EM组血栓抽吸术后TIMI≥2的发生率（69.3%对92.2%，P = 0.0052）和支架置入后MBG≥2的发生率（88.2%对69.3%，P = 0.029）也显著更高。在1个月和12个月时的临床事件方面未观察到显著差异。
在这项单中心、前瞻性、随机研究中，与DI相比，STEMI患者在支架置入前使用EM似乎能清除更多血栓负荷，提供更好的血栓抽吸术后心外膜血流和更好的支架置入后微血管灌注。
