Arnoud W. J. van 't Hof, MD PhD, FESC, Isala Klinieken, Location Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands, Tel.: +31 38 424 2374, Fax: +31 38 424 3222, E-mail:
Thromb Haemost. 2014 Jan;111(1):165-71. doi: 10.1160/TH13-05-0433. Epub 2013 Oct 2.
It was the purpose of this study to assess the effect of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) on reperfusion and clinical outcome in a real-world STEMI population. The decision to use TA (Export catheter, Medtronic) was at the discretion of the treating cardiologist. The primary endpoint was mortality at short (in-hospital) and long term (one year) follow-up. Secondary end points were post-PCI TIMI flow, residual ST deviation and enzymatic infarct size. Cox proportional hazard models (propensity-weighted) and logistic regression analysis were used to adjust for known covariates, associated with mortality. We performed a retrospective analysis of prospectively collected data on 2,552 consecutive PPCI-treated STEMI patients between 2007 and 2010. Use of TA increased from 6.9% in 2007 to 62.2% in 2010 (p<0.001). TA was performed in 899 patients (35.2%). In-hospital and one-year mortality rates were 3.0% and 6.0%, respectively, in the TA group and 3.5% and 7.6% in the no-TA group. After multivariate analysis, TA was not significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 0.70; 95% confidence interval [CI]: 0.33-1.49, p=0.36) nor one year mortality (adjusted hazard ratio [HR]: 0.75, 95%CI: 0.47-1.20, p=0.23) or cardiac mortality (HR: 0.81; 95%CI: 0.45-1.46, p=0.49). After matching on the propensity score, the HR in the TA group for one year mortality was 0.70 (95%CI: 0.41-1.20, p=0.19) and for one-year cardiac mortality 0.70 (95%CI: 0.36-1.34, p=0.28). In conclusion, no significant relationship of TA with one of the secondary end points was found. The use of TA increased over the last years but clinical outcome was similar in both groups (TA vs no-TA) in this large cohort of real-world, unselected STEMI patients.
本研究旨在评估在直接经皮冠状动脉介入治疗（PPCI）中使用血栓抽吸（TA）对真实世界 ST 段抬高型心肌梗死（STEMI）人群再灌注和临床结局的影响。是否使用 TA（Export 导管，美敦力）由治疗心脏病专家决定。主要终点是短期（住院期间）和长期（1 年）随访时的死亡率。次要终点是 PCI 后的 TIMI 血流、残余 ST 段偏移和酶性梗死面积。使用 Cox 比例风险模型（倾向评分加权）和逻辑回归分析调整与死亡率相关的已知协变量。我们对 2007 年至 2010 年期间连续 2552 例接受 PPCI 治疗的 STEMI 患者前瞻性收集的数据进行了回顾性分析。TA 的使用率从 2007 年的 6.9%增加到 2010 年的 62.2%（p<0.001）。在 899 例患者（35.2%）中进行了 TA。TA 组的住院和 1 年死亡率分别为 3.0%和 6.0%，非 TA 组分别为 3.5%和 7.6%。多变量分析后，TA 与住院死亡率（调整后比值比[OR]：0.70；95%置信区间[CI]：0.33-1.49，p=0.36）或 1 年死亡率（调整后风险比[HR]：0.75，95%CI：0.47-1.20，p=0.23）或心源性死亡率（HR：0.81；95%CI：0.45-1.46，p=0.49）无显著相关性。在倾向评分匹配后，TA 组 1 年死亡率的 HR 为 0.70（95%CI：0.41-1.20，p=0.19），1 年心源性死亡率的 HR 为 0.70（95%CI：0.36-1.34，p=0.28）。总之，未发现 TA 与次要终点之一有显著关系。在这个大型真实世界、未经选择的 STEMI 患者队列中，TA 的使用在过去几年中有所增加，但两组的临床结局（TA 组与非 TA 组）相似。
