Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Catheter Cardiovasc Interv. 2013 May;81(6):922-9. doi: 10.1002/ccd.24592. Epub 2012 Oct 3.
The objective of this analysis is to determine the effects on mortality of thrombus aspiration during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) compared with conventional PCI.
Adjunctive thrombus aspiration in STEMI improves markers of myocardial reperfusion but evidence for improved survival is limited to the TAPAS trial.
We used data of 3,750 consecutive STEMI patients treated with either conventional PCI or thrombus aspiration between August 1, 2001 and January 1, 2009. For each patient, a propensity score was calculated based on clinical and angiographic characteristics, predicting a patient's probability of having been treated with thrombus aspiration. This propensity score was used in several ways to account for differences between patients treated with and without thrombus aspiration. In our primary analysis, patients treated with thrombus aspiration were matched one-to-one with patients treated with conventional PCI on their propensity score (1,391 matched pairs). Kaplan Meier and Cox regression models were used to estimate the influence of treatment on one-year mortality.
In total, 1,502 patients (40.1%) were treated with thrombus aspiration. In the propensity matched cohort, after one year 7.2% of patients treated with thrombus aspiration had died compared with 9.3% of patients in the control group. The hazard ratio for one-year mortality in patients treated with thrombus aspiration was 0.76 (95% CI: 0.59-0.99; P = 0.043). The hazard ratio remained materially unaltered and statistically significant in secondary analyses, varying between 0.61 and 0.77.
The routine use of thrombus aspiration was associated with reduced one-year mortality in this large real-world patient cohort. These data support the observed survival benefit in the TAPAS trial.
本分析旨在确定与常规经皮冠状动脉介入治疗（PCI）相比，在急性 ST 段抬高型心肌梗死（STEMI）患者中进行血栓抽吸对死亡率的影响。
在 STEMI 患者中辅助性血栓抽吸可改善心肌再灌注标志物，但生存获益仅限于 TAPAS 试验。
我们使用了 2001 年 8 月 1 日至 2009 年 1 月 1 日期间接受常规 PCI 或血栓抽吸治疗的 3750 例连续 STEMI 患者的数据。为每位患者计算了基于临床和血管造影特征的倾向评分，预测患者接受血栓抽吸治疗的概率。该倾向评分以几种方式用于解释接受血栓抽吸和未接受血栓抽吸治疗的患者之间的差异。在我们的主要分析中，将接受血栓抽吸治疗的患者与接受常规 PCI 治疗的患者按倾向评分进行一对一匹配（1391 对匹配）。使用 Kaplan-Meier 和 Cox 回归模型来估计治疗对一年死亡率的影响。
共有 1502 例（40.1%）患者接受了血栓抽吸治疗。在倾向匹配队列中，接受血栓抽吸治疗的患者一年后死亡率为 7.2%，而对照组患者的死亡率为 9.3%。接受血栓抽吸治疗的患者一年死亡率的风险比为 0.76（95%CI：0.59-0.99；P=0.043）。在二次分析中，风险比在 0.61 至 0.77 之间，仍然具有实质性和统计学意义。
在这个大型真实世界患者队列中，常规使用血栓抽吸与一年死亡率降低相关。这些数据支持 TAPAS 试验中观察到的生存获益。
