Service de cardiologie, CHU Bocage, boulevard de Lattre-de-Tassigny, Dijon cedex, France.
Arch Cardiovasc Dis. 2010 Oct;103(10):522-9. doi: 10.1016/j.acvd.2010.10.002. Epub 2010 Nov 20.
Thrombus aspiration is applicable in a large majority of patients with acute myocardial infarction (AMI) and results in better reperfusion and clinical outcomes compared with percutaneous coronary intervention alone. Some aspiration procedures are, however, ineffective. To date, few clinical data are available on the predictors of successful thrombectomy in the acute phase of myocardial infarction.
To determine the baseline clinical and angiographic characteristics associated with successful thrombectomy.
Consecutive patients with ST elevation myocardial infarction with a baseline TIMI flow of 0 or 1, who underwent thrombus aspiration and primary or rescue angioplasty, were included. The main criterion for evaluation was an effective or ineffective aspiration defined, respectively, by the presence or absence of atherothrombotic material in the aspirate samples.
Among the 180 patients included, material was collected in 155 patients (86%). Patients with the presence of material were younger (61 vs 74 years, P=0.015), less frequently hypertensive (41% vs 68%, P=0.023) and had a lower systolic blood pressure at admission (135 vs 148 mmHg, P=0.031). No difference was observed between the two groups for angiographic parameters except for visible thrombus (61% vs 28%, P=0.005) and calcification (37% vs 60%, P=0.048). In multivariable analysis, the ability to remove the clot was affected by: age greater than 70 years (odds ratio 0.18, 95% confidence interval 0.06-0.51; P=0.001), admission systolic blood pressure (0.97, 0.95-0.99; P=0.003) and thrombus seen on angiography (4.54, 1.54-13.45, P=0.006).
The present study showed that manual thrombus aspiration is effective in most, but not all, patients. Further studies are needed to develop more efficient aspiration techniques and other aspiration devices to improve the results of such procedures.
血栓抽吸术适用于大多数急性心肌梗死（AMI）患者，与单纯经皮冠状动脉介入治疗相比，可实现更好的再灌注和临床结局。然而，某些抽吸术可能无效。迄今为止，关于急性心肌梗死阶段血栓切除术成功的预测因素，临床数据有限。
确定与血栓切除术成功相关的基线临床和血管造影特征。
连续纳入基线 TIMI 血流为 0 或 1 的 ST 段抬高型心肌梗死患者，行血栓抽吸术及直接或补救性经皮冠状动脉成形术。主要评估标准为抽吸样本中存在或不存在动脉粥样血栓物质定义的有效或无效抽吸。
在纳入的 180 例患者中，155 例（86%）采集到了物质。有物质的患者更年轻（61 岁 vs 74 岁，P=0.015）、较少患有高血压（41% vs 68%，P=0.023）且入院时收缩压较低（135 毫米汞柱 vs 148 毫米汞柱，P=0.031）。两组间的血管造影参数无差异，除了可见血栓（61% vs 28%，P=0.005）和钙化（37% vs 60%，P=0.048）。多变量分析显示，清除血栓的能力受以下因素影响：年龄大于 70 岁（比值比 0.18，95%置信区间 0.06-0.51；P=0.001）、入院时收缩压（0.97，0.95-0.99；P=0.003）和血管造影上看到的血栓（4.54，1.54-13.45，P=0.006）。
本研究表明，手动血栓抽吸术在大多数而非所有患者中有效。需要进一步研究以开发更有效的抽吸技术和其他抽吸设备，以提高此类操作的结果。
