Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Catheter Cardiovasc Interv. 2013 Oct 1;82(4):594-601. doi: 10.1002/ccd.24705. Epub 2013 Jun 26.
To assess the quality of coronary reperfusion and long-term clinical outcomes of patients enrolled in the HORIZONS-AMI trial according to the use of thrombus aspiration (TA).
The impact of manual TA on microvascular perfusion and clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is unsettled.
In this retrospective, nonrandomized, subgroup analysis, the authors evaluated thrombolysis in myocardial infarction (TIMI) flow, tissue myocardial perfusion grade (TMPG), ST-segment resolution (STR), net adverse clinical events (NACE), and major adverse cardiac events (MACE) in patients undergoing pPCI with or without manual TA.
A total of 318 patients had pPCI with upfront TA, and 2,917 patients had pPCI without TA. Patients who had TA were more likely to have TIMI 0/1 flow at baseline (75.1% vs. 63.7%, P < 0.0001). There was no difference in the rates of final TIMI 3 flow (90.2% vs. 92.3%, P = 0.19) or dynamic TMPG 2-3 (77.4% vs. 76.4%, P = 0.68). STR ≥70% was similar in both groups at 60 minutes but higher in the TA group at discharge (71.8% vs. 64.6%, P = 0.02). After multivariable adjustment, TA did not predict MACE at 30 days (HR 0.96 [0.51-1.80], P = 0.90), 1 year (HR 1.03 [0.68-1.55], P = 0.89), or 3 years (HR 1.13 [0.86-1.48], P = 0.39). Stent thrombosis did not differ at 1 year or 3 years.
In STEMI patients undergoing pPCI, the use of manual TA was associated with improved STR at discharge, but not with any difference in final TIMI flow, TMPG, or MACE.
根据血栓抽吸术（TA）的使用情况，评估 HORIZONS-AMI 试验中接受经皮冠状动脉介入治疗（pPCI）的患者的冠状动脉再灌注质量和长期临床结局。
手动 TA 对行直接 pPCI 的 ST 段抬高型心肌梗死（STEMI）患者微血管灌注和临床结局的影响尚不确定。
在这项回顾性、非随机亚组分析中，作者评估了接受直接 pPCI 的患者中有无手动 TA 对血栓溶解心肌梗死（TIMI）血流、心肌组织灌注分级（TMPG）、ST 段缓解（STR）、净不良临床事件（NACE）和主要不良心脏事件（MACE）的影响。
共 318 例患者行直接 pPCI 并进行了 TA，2917 例患者行直接 pPCI 但未进行 TA。有 TA 的患者基线 TIMI 0/1 级血流的比例更高（75.1% vs. 63.7%，P < 0.0001）。最终 TIMI 3 级血流（90.2% vs. 92.3%，P = 0.19）和动态 TMPG 2-3 级（77.4% vs. 76.4%，P = 0.68）的比例无差异。两组 60 分钟时 STR ≥70%的比例相似，但 TA 组出院时更高（71.8% vs. 64.6%，P = 0.02）。多变量调整后，TA 并未预测 30 天时（HR 0.96[0.51-1.80]，P = 0.90）、1 年时（HR 1.03[0.68-1.55]，P = 0.89）或 3 年时（HR 1.13[0.86-1.48]，P = 0.39）的 MACE。1 年和 3 年时支架血栓形成率无差异。
在 STEMI 患者中，行直接 pPCI 时使用手动 TA 与出院时 STR 改善相关，但与最终 TIMI 血流、TMPG 或 MACE 无差异。
