Department of Medicine, Echocardiography, and Noninvasive Cardiology Service, Montreal Heart Institute, Canada.
Circ Cardiovasc Interv. 2010 Feb 1;3(1):6-16. doi: 10.1161/CIRCINTERVENTIONS.109.904037. Epub 2010 Jan 26.
In available trials and meta-analyses, adjunctive thrombectomy in acute myocardial infarction (MI) improves markers of myocardial reperfusion but has limited effects on clinical outcomes. Thrombectomy devices simply aspirate thrombus or mechanically fragment it before aspiration. Simple aspiration thrombectomy may offer a distinct advantage.
We identified 21 eligible trials (16 that used a simple aspiration thrombectomy device) involving 4299 patients with ST-segment elevation MI randomized to reperfusion therapy by primary percutaneous coronary intervention with or without thrombectomy. By using Bayesian meta-analysis methods, we found that thrombectomy yielded substantially less no-reflow (odds ratio [OR], 0.39; 95% credible interval [CrI], 0.18 to 0.69), more ST-segment resolution > or =50% (OR, 2.22; 95% CrI, 1.60 to 3.23), and more thrombolysis in myocardial infarction/myocardial perfusion grade 3 (OR, 2.50; 95% CrI, 1.48 to 4.41). There was no evidence for a decrease in death (OR, 0.94; 95% CrI, 0.47 to 1.80), death, recurrent MI, or stroke (OR, 1.07; 95% CrI, 0.63 to 1.92) with thrombectomy. Restriction of the analysis to trials that used simple aspiration thrombectomy devices did not yield substantially different results, except for a positive effect on postprocedure thrombolysis in myocardial infarction grade 3 flow (OR, 1.49; 95% CrI, 1.14 to 1.99).
In this Bayesian meta-analysis, adjunctive thrombectomy improves early markers of reperfusion but does not substantially effect 30-day post-MI mortality, reinfarction, and stroke. The use of aspiration thrombectomy devices is not associated with a reduction in post-MI clinical outcomes. Thrombectomy is one of the rare effective preventive measures against no-reflow.
在现有的试验和荟萃分析中，急性心肌梗死（MI）的辅助血栓切除术改善了心肌再灌注的标志物，但对临床结果的影响有限。血栓切除术设备只是在抽吸前抽吸或机械地将血栓碎裂。单纯抽吸血栓切除术可能具有明显优势。
我们确定了 21 项符合条件的试验（其中 16 项使用了单纯抽吸血栓切除术设备），涉及 4299 例 ST 段抬高型 MI 患者，这些患者随机接受经皮冠状动脉介入治疗联合或不联合血栓切除术进行再灌注治疗。通过使用贝叶斯荟萃分析方法，我们发现血栓切除术可显著减少无再流（比值比[OR]，0.39；95%可信区间[CrI]，0.18 至 0.69），增加 ST 段缓解≥50%（OR，2.22；95% CrI，1.60 至 3.23），增加心肌梗死溶栓/心肌灌注分级 3（OR，2.50；95% CrI，1.48 至 4.41）。血栓切除术并未降低死亡率（OR，0.94；95% CrI，0.47 至 1.80）、死亡、再发性 MI 或卒中（OR，1.07；95% CrI，0.63 至 1.92）。对仅使用单纯抽吸血栓切除术设备的试验进行分析，并未得到明显不同的结果，只是对术后心肌梗死溶栓分级 3 级血流有积极影响（OR，1.49；95% CrI，1.14 至 1.99）。
在这项贝叶斯荟萃分析中，辅助血栓切除术改善了早期再灌注标志物，但对 MI 后 30 天的死亡率、再梗死和卒中没有显著影响。使用抽吸血栓切除术设备与 MI 后临床结局的降低无关。血栓切除术是少数有效的无再流预防措施之一。
