Siudak Zbigniew, Mielecki Waldemar, Dziewierz Artur, Rakowski Tomasz, Legutko Jacek, Bartuś Stanisław, Bryniarski Krzysztof L, Partyka Łukasz, Dudek Dariusz
Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland.
Catheter Cardiovasc Interv. 2015 Jan 1;85(1):E16-22. doi: 10.1002/ccd.25572. Epub 2014 Jun 18.
Current STEMI guidelines recommend thrombectomy should be considered during primary PCI. Multiple data from randomized clinical trials, registries, and metanalysis have confirmed the efficacy of thrombectomy in terms of surrogate endpoints like better myocardial perfusion, less pronounced distal embolization, and conflicting results on lower all-cause mortality. Our aim was to analyze long-term outcome of STEMI patients treated with manual thrombectomy during primary PCI in a contemporary national registry.
There were 13 catheterization laboratories in Poland that enrolled patients in NRDES Registry. Patients were divided into two groups: those that were treated with manual thrombectomy for their primary PCI vs. those who were not.
There were altogether 2,686 patients enrolled in the NRDES Registry of whom 1,763 were diagnosed with STEMI (66%). Aspiration thrombectomy was used in 673 of these cases (38%) and 1,090 (62%) patients were treated without thrombectomy during the index primary PCI. Overall mortality at 1 year was 11.03% in thrombectomy and 7.46% in no thrombectomy group respectively (P = 0.0292 which became insignificant after propensity score matching adjustment P = 0.613). Specific subgroup analyses revealed that there was no benefit from aspiration thrombectomy in neither subgroup.
Manual aspiration thrombectomy in patients undergoing primary PCI for STEMI was not associated with improved long-term 1-year clinical outcome. Subgroup analysis did not reveal any specific setting in which thrombectomy would be clinically superior. © 2014 Wiley Periodicals, Inc.
当前ST段抬高型心肌梗死（STEMI）指南建议在直接经皮冠状动脉介入治疗（PCI）期间应考虑进行血栓切除术。来自随机临床试验、登记处和荟萃分析的多项数据已证实，血栓切除术在诸如更好的心肌灌注、不太明显的远端栓塞等替代终点方面具有疗效，而在降低全因死亡率方面结果存在争议。我们的目的是在一个当代国家登记处分析直接PCI期间接受手动血栓切除术治疗的STEMI患者的长期结局。
波兰有13个导管实验室将患者纳入国家直接经皮冠状动脉介入治疗登记处（NRDES）。患者分为两组：一组在直接PCI时接受手动血栓切除术治疗，另一组未接受。
NRDES登记处共纳入2686例患者，其中1763例被诊断为STEMI（66%）。这些病例中有673例（38%）使用了抽吸血栓切除术，1090例（62%）患者在首次直接PCI期间未进行血栓切除术。血栓切除术组1年总死亡率为11.03%，未进行血栓切除术组为7.46%（P = 0.0292，倾向评分匹配调整后无统计学意义，P = 0.613）。特定亚组分析显示，抽吸血栓切除术在任何亚组中均无益处。
STEMI患者在直接PCI时进行手动抽吸血栓切除术与1年长期临床结局改善无关。亚组分析未发现血栓切除术在临床上更具优势的任何特定情况。© 2014威利期刊公司。
