Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
JACC Cardiovasc Interv. 2011 Jun;4(6):634-42. doi: 10.1016/j.jcin.2011.03.009.
This study sought to investigate which factors are associated with failure of thrombus aspiration (TA) and if this has prognostic implications.
The pathophysiological mechanism and clinical benefit of TA during primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction is still in debate.
Between August 2001 and October 2007, TA was attempted in 1,399 patients. Failure of TA was defined as the inability to reach and/or cross the occlusion with the aspiration catheter for effective thrombus removal. In addition, we analyzed patients in which no material could be obtained. We examined baseline clinical and angiographic variables related to failure of TA or to the lack of aspirate. Follow-up on vital status was obtained at 1 year.
In 144 (10.3%) patients, the aspiration catheter failed to cross the lesion. After multivariable adjustment, marked proximal tortuosity (odds ratio [OR]: 2.88, 95% confidence interval [CI]: 1.92 to 4.31, p < 0.001), the presence of a calcified lesion (OR: 2.70, 95% CI: 1.77 to 4.13, p < 0.001), and a bifurcation lesion (OR: 1.97, 95% CI: 1.15 to 3.37, p = 0.013) were independent predictors of failed TA. Age over 60 years and the circumflex as infarct-related artery were associated with the lack of aspirate. Mortality rates at 1 year were 6.2% in patients with failed TA and 6.4% with successful TA (hazard ratio: 0.98, 95% CI: 0.49 to 1.95, p = 0.95).
The presence of marked proximal tortuosity of the infarct-related artery, a calcified lesion, and a bifurcation lesion are independent predictors of failure of thrombus aspiration. We found that unsuccessful TA did not affect 1-year mortality.
本研究旨在探讨哪些因素与血栓抽吸（TA）失败相关，以及这是否具有预后意义。
在急性 ST 段抬高型心肌梗死的直接经皮冠状动脉介入治疗中，TA 的病理生理机制和临床获益仍存在争议。
在 2001 年 8 月至 2007 年 10 月期间，对 1399 例患者进行了 TA。TA 失败的定义为抽吸导管无法到达和/或穿过闭塞部位，以进行有效的血栓清除。此外，我们还分析了未能获得抽吸材料的患者。我们检查了与 TA 失败或抽吸物缺乏相关的基线临床和血管造影变量。在 1 年时获得了生存状态的随访。
在 144 例（10.3%）患者中，抽吸导管未能穿过病变部位。经过多变量调整，明显的近端迂曲（优势比 [OR]：2.88，95%置信区间 [CI]：1.92 至 4.31，p<0.001）、存在钙化病变（OR：2.70，95% CI：1.77 至 4.13，p<0.001）和分叉病变（OR：1.97，95% CI：1.15 至 3.37，p=0.013）是 TA 失败的独立预测因素。年龄大于 60 岁和回旋支作为梗死相关动脉与抽吸物缺乏相关。TA 失败患者的 1 年死亡率为 6.2%，TA 成功患者为 6.4%（风险比：0.98，95% CI：0.49 至 1.95，p=0.95）。
梗死相关动脉明显的近端迂曲、钙化病变和分叉病变的存在是 TA 失败的独立预测因素。我们发现，不成功的 TA 并不影响 1 年死亡率。
