经皮冠状动脉介入治疗中常规血栓抽吸与 ST 段恢复的关系：抽吸血栓的组织病理学研究。

Histopathology of aspirated thrombus and its association with ST-segment recovery in patients undergoing primary percutaneous coronary intervention with routine thrombus aspiration.

机构信息

Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.

出版信息

Catheter Cardiovasc Interv. 2011 Jan 1;77(1):35-42. doi: 10.1002/ccd.22616.

DOI:10.1002/ccd.22616

PMID:20506526

Abstract

BACKGROUND

In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with thrombus aspiration, the histopathology of aspirated thrombus was previously related to long-term mortality. In this study, we sought to investigate the association between histopathology of aspirated thrombus and ST-segment recovery, a marker of microvascular dysfunction, immediately at the end of the PCI procedure.

METHODS

We included 892 STEMI patients who underwent primary PCI with routine thrombus aspiration and for whom combined data on histopathology of aspirated thrombus and ST-segment recovery were available. Patients were categorized according to histopathology of aspirated thrombus: fresh only (<1 day), older (>1 day), or no material aspirated. ST-segment recovery was defined as incomplete if <50%.

RESULTS

Incomplete ST-segment recovery occurred in 134 of 363 patients (37%) with fresh thrombus, in 104 of 238 patients (44%) with older thrombus, and in 142 of 291 patients (49%) with no material. Unadjusted odds ratios for incomplete ST-segment recovery of patients with older thrombus and no material, when compared with patients with fresh thrombus, were 1.33 (95% CI, 0.95-1.85; P = 0.097) and 1.63 (95% CI 1.19-2.23; P = 0.002), respectively. Both associations were unchanged after multivariable adjustment for clinical predictors of ST-segment recovery. ST-segment recovery was a strong predictor of long-term mortality, independent of the histopathology of aspirated thrombus.

CONCLUSIONS

This study shows that ST-segment recovery immediately at the end of the PCI procedure was a significant prognosticator, independent of the histopathology of aspirated thrombus. We found that the histopathology of aspirated thrombus (fresh, older, no material) was associated with ST-segment recovery in STEMI patients undergoing primary PCI with thrombus aspiration.

摘要

背景

在接受经皮冠状动脉介入治疗（PCI）伴血栓抽吸的 ST 段抬高型心肌梗死（STEMI）患者中，抽吸血栓的组织病理学曾与长期死亡率相关。在这项研究中，我们试图研究抽吸血栓的组织病理学与 PCI 操作结束时即时的 ST 段恢复（微血管功能障碍的标志物）之间的关系。

方法

我们纳入了 892 例接受常规血栓抽吸的 STEMI 患者，且这些患者同时有抽吸血栓的组织病理学和 ST 段恢复的综合数据。患者根据抽吸血栓的组织病理学分为：新鲜血栓（<1 天）、陈旧血栓（>1 天）或无抽吸物。如果<50%，则定义为 ST 段恢复不完全。

结果

在 363 例新鲜血栓患者中，有 134 例（37%）出现不完全 ST 段恢复，在 238 例陈旧血栓患者中，有 104 例（44%）出现不完全 ST 段恢复，在 291 例无抽吸物患者中，有 142 例（49%）出现不完全 ST 段恢复。与新鲜血栓患者相比，陈旧血栓和无抽吸物患者出现不完全 ST 段恢复的未调整比值比分别为 1.33（95%CI，0.95-1.85；P=0.097）和 1.63（95%CI，1.19-2.23；P=0.002）。在对 ST 段恢复的临床预测因素进行多变量调整后，这两种关联均未改变。ST 段恢复是长期死亡率的有力预测指标，与抽吸血栓的组织病理学无关。