Fokkema Marieke L, Vlaar Pieter J, Svilaas Tone, Vogelzang Mathijs, Amo Diny, Diercks Gilles F H, Suurmeijer Albert J H, Zijlstra Felix
Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB Groningen, The Netherlands.
Eur Heart J. 2009 Apr;30(8):908-15. doi: 10.1093/eurheartj/ehp033. Epub 2009 Feb 18.
We investigated the incidence and sequelae of angiographically visible distal embolization (AVDE) after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction patients treated with aspirin, heparin, clopidogrel, and glycoprotein-IIb/IIIa inhibitors.
As part of TAPAS, AVDE was a predefined secondary endpoint. We compared angiographic and clinical characteristics, and outcomes of patients with and without AVDE after PCI. AVDE was present on 6.3% of 883 post-procedural angiograms. Angiographically visible distal embolization was associated with significantly worse outcomes, as expressed by lower myocardial blush grade, impaired ST-segment resolution, and higher enzyme levels (all P </= 0.001). Mortality 1 year after PCI was 4 of 56 (7.1%) in patients with AVDE and 43 of 827 (5.2%) in patients without AVDE (P= ns), re-infarction occurred in 5 of 56 (8.9%), and 25 of 827 (3.0%) patients (P = 0.018). The thrombus aspirate more often contained erythrocytes in patients with AVDE than in patients without AVDE (50.0% vs. 15.7%, P < 0.001), and the size of the aspirated thrombus was larger in patients with AVDE (P = 0.002).
In patients with triple anti-platelet therapy, the incidence of AVDE after PCI is low, compared with previous reports. Nevertheless, AVDE is associated with impaired myocardial reperfusion and poor outcome. Thrombus composition and size are related to AVDE after PCI.
我们研究了在接受阿司匹林、肝素、氯吡格雷和糖蛋白IIb/IIIa抑制剂治疗的ST段抬高型心肌梗死患者中，初次经皮冠状动脉介入治疗（PCI）后血管造影可见的远端栓塞（AVDE）的发生率和后遗症。
作为TAPAS研究的一部分，AVDE是一个预先定义的次要终点。我们比较了PCI后有和没有AVDE的患者的血管造影和临床特征以及结局。在883例术后血管造影中，6.3%出现了AVDE。血管造影可见的远端栓塞与明显更差的结局相关，表现为心肌灌注分级更低、ST段分辨率受损和酶水平更高（所有P≤0.001）。PCI后1年，有AVDE的56例患者中有4例（7.1%）死亡，无AVDE的827例患者中有43例（5.2%）死亡（P=无显著差异），有AVDE的56例患者中有5例（8.9%）再次梗死，827例患者中有25例（3.0%）再次梗死（P = 0.018）。与没有AVDE的患者相比，有AVDE的患者血栓抽吸物中红细胞的含量更常见（50.0%对15.7%，P < 0.001），有AVDE的患者抽吸血栓的大小更大（P = 0.002）。
与先前的报告相比，在接受三联抗血小板治疗的患者中，PCI后AVDE的发生率较低。然而，AVDE与心肌再灌注受损和不良结局相关。血栓成分和大小与PCI后的AVDE有关。
