Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Cardiovascular Department, University Hospital of Trieste, Trieste, Italy.
Catheter Cardiovasc Interv. 2013 Oct 1;82(4):604-11. doi: 10.1002/ccd.24837. Epub 2013 Mar 5.
Previous studies failed to assess the individual prognostic role of thrombus aspiration (TA) or abciximab in primary percutaneous coronary intervention (pPCI), due their prevalent combined use.
A total of 644 consecutive ST-segment elevation myocardial infarction patients treated with pPCI were included in this retrospective registry from January 2006 to December 2008. Patients were divided in: (a) Group 1, with conventional pPCI; (b) Group 2, with pPCI and abciximab; (c) Group 3, with pPCI and TA; (d) Group 4, with pPCI and abciximab plus TA. Primary end point was the composite of major adverse cardiovascular events (MACEs, defined as overall mortality, myocardial infarction, target vessel revascularization, and major bleedings) at 1 year. Baseline clinical and angiographic characteristics were not different among the groups, with the exception of a younger age in group 4. The two groups of patients treated with TA (group 3 and 4) received more frequently direct stenting (P < 0.001 vs. group 1 for both), presented higher rate of end-procedural TIMI flow grade 3 (P < 0.001 vs. group 1 for both), and lower rate of no-reflow (P = 0.016 and P < 0.001 vs. group 1, respectively). Patients of group 2 presented a borderline nonsignificant trend toward higher rate of end-procedural TIMI flow grade 3 (P = 0.083 vs. group 1). MACEs at 1 year were 43 (29%) in group 1 versus 25 (22%) in group 2 versus 24 (19%) in group 3 versus 32 (13%) in group 4 (log-rank P = 0.001). At the multivariate Cox regression analysis, combined TA plus abciximab in group 4 [hazard ratio (HR): 0.48, confidence interval (CI) 95% 0.28-0.84, P = 0.01] and a higher left ventricular ejection fraction (HR: 0.97, CI 95% 0.95-0.98, P < 0.001) were significantly associated with lower MACE rate.
The combination of pharmacologic and mechanic antithrombotic treatment during pPCI was associated with better 1-year clinical outcome.
之前的研究由于血栓抽吸术（TA）和阿昔单抗普遍联合使用，未能评估其在直接经皮冠状动脉介入治疗（pPCI）中的单独预后作用。
本回顾性注册研究纳入了 2006 年 1 月至 2008 年 12 月期间接受 pPCI 治疗的 644 例 ST 段抬高型心肌梗死患者。患者分为：（a）常规 pPCI 的第 1 组；（b）接受 pPCI 和阿昔单抗的第 2 组；（c）接受 pPCI 和 TA 的第 3 组；（d）接受 pPCI、阿昔单抗和 TA 的第 4 组。主要终点为 1 年时的主要不良心血管事件（MACE，定义为全因死亡率、心肌梗死、靶血管血运重建和大出血）的复合终点。各组间的基线临床和血管造影特征无差异，第 4 组患者的年龄较其他组小。接受 TA（第 3 组和第 4 组）治疗的两组患者更常接受直接支架置入术（两组均 P<0.001），术中达到血流 TIMI 3 级的比例更高（两组均 P<0.001），无复流的比例更低（分别为 P=0.016 和 P<0.001）。第 2 组患者术中达到血流 TIMI 3 级的比例有高于第 1 组的趋势，但无统计学意义（P=0.083）。第 1 组、第 2 组、第 3 组和第 4 组的 1 年 MACE 发生率分别为 43（29%）、25（22%）、24（19%）和 32（13%）（log-rank P=0.001）。多变量 Cox 回归分析显示，第 4 组中联合使用 TA 和阿昔单抗（风险比[HR]：0.48，95%置信区间[CI] 0.28-0.84，P=0.01）和更高的左心室射血分数（HR：0.97，95%CI 0.95-0.98，P<0.001）与较低的 MACE 发生率相关。
在直接 pPCI 期间联合使用药物和机械抗血栓治疗与更好的 1 年临床结局相关。
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