血栓抽吸对直接经皮冠状动脉介入治疗后心肌组织再灌注及左心室功能恢复和重构的影响。

Impact of thrombus aspiration on myocardial tissue reperfusion and left ventricular functional recovery and remodeling after primary angioplasty.

机构信息

Cardiovascular Department, San Donato Hospital, Arezzo, Italy.

出版信息

Circ Cardiovasc Interv. 2009 Oct;2(5):376-83. doi: 10.1161/CIRCINTERVENTIONS.109.852665. Epub 2009 Sep 15.

DOI:10.1161/CIRCINTERVENTIONS.109.852665

PMID:20031746

Abstract

BACKGROUND

Failure to achieve myocardial reperfusion often occurs during percutaneous coronary intervention (PCI) in patients with myocardial infarction with ST-segment elevation. We hypothesized that manual thrombus aspiration during primary PCI would favorably influence tissue-level myocardial perfusion and left ventricular (LV) functional recovery and remodeling.

METHODS AND RESULTS

We prospectively randomized 111 patients with ST-segment elevation myocardial infarction to either standard or thrombus-aspiration PCI. Primary end point of the study was postprocedural incidence of ST-segment resolution >or=70%. Secondary end points included Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grade >or=2, the combination of TIMI myocardial perfusion grade >or=2 and ST-segment resolution >or=70%, post-PCI TIMI grade 3 flow, corrected TIMI frame count, myocardial contrast echocardiography score index, the absence of persistent ST-segment deviation, and time course of wall-motion score index, LV ejection fraction, and LV volume in the 2 groups. The incidence of ST-segment resolution >or=70% was 71% and 39% in the thrombus-aspiration and standard PCI groups, respectively (odds ratio, 3.7; 95% CI, 1.7 to 8.3; P=0.001). TIMI myocardial perfusion grade >or=2 was attained in 93% in the thrombus-aspiration group compared with 71% in the standard PCI group (P=0.006). The percentage of patients with ST-segment resolution >or=70% and TIMI myocardial perfusion grade >or=2 was significantly greater in the thrombus-aspiration group compared with the standard PCI group (69% versus 36%, P=0.0006). Myocardial contrast echocardiography score index was significantly higher in the thrombus-aspiration group compared with the standard PCI group (0.86+/-0.20 versus 0.65+/-0.31; P<0.0001). A significantly greater improvement in LV ejection fraction and in wall-motion score index from baseline to 6-month follow-up was observed in the thrombus-aspiration group compared with the standard PCI group (LV ejection fraction from 48+/-6% to 55+/-6% versus 48.7+/-7% to 49+/-8%, P<0.0001; wall-motion score index from 1.59+/-0.13 to 1.31+/-0.19 versus 1.64+/-0.20 to 1.51+/-0.26, P=0.008). Twelve patients (11%) developed LV remodeling at 6 months, 2 (4%) in the thrombus-aspiration group and 10 (18%) in the standard PCI group (P=0.02).

CONCLUSIONS

Manual thrombus aspiration in the setting of primary PCI improves myocardial tissue-level perfusion as well as LV functional recovery and remodeling.

摘要

背景

在 ST 段抬高型心肌梗死患者行经皮冠状动脉介入治疗（PCI）时，常发生心肌再灌注失败。我们假设在直接 PCI 中进行手动血栓抽吸将有利于影响组织水平的心肌灌注和左心室（LV）功能恢复和重构。

方法和结果

我们前瞻性随机将 111 例 ST 段抬高型心肌梗死患者分为标准 PCI 组或血栓抽吸 PCI 组。研究的主要终点是术后 ST 段缓解>或=70%的发生率。次要终点包括血栓溶解心肌梗死（TIMI）心肌灌注分级>或=2、TIMI 心肌灌注分级>或=2 和 ST 段缓解>或=70%、PCI 后 TIMI 分级 3 级血流、校正 TIMI 帧数计数、心肌对比超声心动图评分指数、无持续 ST 段偏移和两组的壁运动评分指数、LV 射血分数和 LV 容积的时间过程。血栓抽吸组和标准 PCI 组的 ST 段缓解>或=70%的发生率分别为 71%和 39%（比值比，3.7；95%CI，1.7 至 8.3；P=0.001）。血栓抽吸组 93%的患者达到 TIMI 心肌灌注分级>或=2，而标准 PCI 组为 71%（P=0.006）。与标准 PCI 组相比，血栓抽吸组达到 ST 段缓解>或=70%和 TIMI 心肌灌注分级>或=2的患者比例显著更高（69%比 36%，P=0.0006）。与标准 PCI 组相比，血栓抽吸组的心肌对比超声心动图评分指数显著更高（0.86+/-0.20 比 0.65+/-0.31；P<0.0001）。与标准 PCI 组相比，血栓抽吸组的 LV 射血分数和壁运动评分指数从基线到 6 个月随访的改善更显著（LV 射血分数从 48+/-6%到 55+/-6%，比 48.7+/-7%到 49+/-8%，P<0.0001；壁运动评分指数从 1.59+/-0.13 到 1.31+/-0.19，比 1.64+/-0.20 到 1.51+/-0.26，P=0.008）。6 个月时 12 例（11%）患者发生 LV 重构，血栓抽吸组 2 例（4%），标准 PCI 组 10 例（18%）（P=0.02）。