University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
JACC Cardiovasc Interv. 2016 Jan 25;9(2):113-22. doi: 10.1016/j.jcin.2015.09.010.
The aim of this study was to examine whether manual thrombus aspiration reduces microvascular obstruction assessed by cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction (STEMI) presenting late after symptom onset.
Thrombus aspiration is an established treatment option in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). However, there are only limited data on the efficacy of thrombus aspiration in patients with STEMI presenting ≥12 h after symptom onset.
Patients with subacute STEMI presenting ≥12 and ≤48 h after symptom onset were randomized to primary PCI with or without manual thrombus aspiration in a 1:1 ratio. Patients underwent cardiac magnetic resonance imaging 1 to 4 days after randomization. The primary endpoint was the extent of microvascular obstruction.
A total of 152 patients underwent randomization. The mean time between symptom onset and PCI was 28 ± 12 h. Baseline characteristics were comparable between groups. The majority of patients (60%) showed at least a moderate amount of viable myocardium in the affected region. Extent of microvascular obstruction was not significantly different between patients assigned to thrombus aspiration and the control group (2.5 ± 4.0% vs. 3.1 ± 4.4% of left ventricular mass, p = 0.47). There were also no significant differences in infarct size, myocardial salvage, left ventricular ejection fraction, and angiographic and clinical endpoints between groups.
In this first randomized trial of thrombectomy in patients with STEMI presenting late after symptom onset, routine thrombus aspiration before PCI failed to show a benefit for markers of reperfusion success. (Effect of Thrombus Aspiration in Patients With Myocardial Infarction Presenting Late After Symptom Onset; NCT01379248).
本研究旨在探讨在症状发作后延迟至 12 小时以上的 ST 段抬高型心肌梗死（STEMI）患者中，手动血栓抽吸是否能降低心脏磁共振成像评估的微血管阻塞。
血栓抽吸是在接受直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者中一种既定的治疗选择。然而，关于在症状发作后延迟至 12 小时以上的 STEMI 患者中血栓抽吸的疗效，仅有有限的数据。
在症状发作后延迟 12 小时至 48 小时的亚急性期 STEMI 患者中，按照 1:1 的比例随机分为接受直接 PCI 联合或不联合手动血栓抽吸的治疗组。患者在随机分组后 1 至 4 天进行心脏磁共振成像检查。主要终点是微血管阻塞的程度。
共有 152 名患者进行了随机分组。症状发作至 PCI 的中位时间为 28±12 小时。两组间的基线特征相当。大多数患者（60%）在受影响区域显示至少中等量的存活心肌。血栓抽吸组和对照组患者的微血管阻塞程度无显著差异（左心室质量的 2.5%±4.0%与 3.1%±4.4%，p=0.47）。两组间的梗死面积、心肌挽救、左心室射血分数以及血管造影和临床终点也无显著差异。
在该首次针对症状发作后延迟的 STEMI 患者进行的血栓切除术随机试验中，在 PCI 前常规进行血栓抽吸未能显示对再灌注成功标志物有获益。（血栓抽吸对症状发作后延迟的心肌梗死患者的影响；NCT01379248）。
