Cardiovascular Department, San Donato Hospital, Arezzo, Italy.
Circ Cardiovasc Interv. 2009 Oct;2(5):376-83. doi: 10.1161/CIRCINTERVENTIONS.109.852665. Epub 2009 Sep 15.
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.
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).
Manual thrombus aspiration in the setting of primary PCI improves myocardial tissue-level perfusion as well as LV functional recovery and remodeling.
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。
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）。
直接 PCI 中进行手动血栓抽吸可改善心肌组织水平灌注以及 LV 功能恢复和重构。
