Olivecrona Göran K, Lagerqvist Bo, Fröbert Ole, Gudnason Thórarinn, Maeng Michael, Råmunddal Truls, Haupt Jan, Kellerth Thomas, Stewart Jason, Sarno Giovanna, Jensen Jens, Östlund Ollie, James Stefan K
Department of Cardiology, Skane University Hospital, Lund University, Lund, 221 85, Sweden.
Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
BMC Cardiovasc Disord. 2016 Apr 1;16:62. doi: 10.1186/s12872-016-0238-y.
Routine thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) did not reduce the primary composite endpoint in the "A Randomised Trial of Routine Aspiration ThrOmbecTomy With PCI Versus PCI ALone in Patients With STEMI Undergoing Primary PCI" (TOTAL) trial. We aimed to analyse a similar endpoint in "The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia" (TASTE) trial up to 180 days.
In TASTE, 7244 patients with STEMI were randomised to thrombus aspiration followed by PCI or to PCI alone. We analysed the quadruple composite endpoint of cardiovascular death, cardiogenic shock, rehospitalisation for myocardial infarction, or new hospitalisation for heart failure. Furthermore, an extended net-benefit composite endpoint including stent thrombosis, target vessel revascularization or stroke within 180 days was analysed.
The primary quadruple composite endpoint occurred in 8.7 % (316 of 3621) in the thrombus aspiration group compared to 9.3 % (338 of 3623) in the PCI alone group (hazard ratio (HR), 0.93; 95 % confidence interval (CI); 0.80 - 1.09, P = 0.36) and the extended net-benefit composite endpoint in 12.0 % (436) vs. 13.2 % (479) (HR, 0.90; 95 % CI; 0.79 - 1.03, P = 0.12). Stroke within 30 days occurred in 0.7 % (27) vs. 0.7 % (24) (HR, 0.89; 95 % CI; 0.51-1.54, P = 0.68).
A large and an extended composite endpoint analysis from the TASTE trial did not demonstrate any clinical benefit of routine thrombus aspiration during PCI in patients with STEMI. There was no evidence of an increased risk of stroke with thrombus aspiration.
在“ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗（PCI）时常规血栓抽吸与单纯PCI的随机试验”（TOTAL）试验中，ST段抬高型心肌梗死（STEMI）患者在直接PCI期间进行常规血栓抽吸并未降低主要复合终点事件发生率。我们旨在分析“斯堪的纳维亚ST段抬高型心肌梗死血栓抽吸”（TASTE）试验中长达180天的类似终点事件。
在TASTE试验中，7244例STEMI患者被随机分为血栓抽吸后行PCI组或单纯PCI组。我们分析了心血管死亡、心源性休克、因心肌梗死再次住院或因心力衰竭首次住院的四重复合终点事件。此外，还分析了一个扩展的净效益复合终点事件，包括180天内的支架血栓形成、靶血管血运重建或卒中。
血栓抽吸组主要四重复合终点事件发生率为8.7%（3621例中的316例），单纯PCI组为9.3%（3623例中的338例）（风险比（HR）为0.93；95%置信区间（CI）为0.80 - 1.09，P = 0.36）；扩展的净效益复合终点事件发生率分别为12.0%（436例）和13.2%（479例）（HR为0.90；95%CI为0.79 - 1.03，P = 0.12）。30天内卒中发生率分别为0.7%（27例）和0.7%（24例）（HR为0.89；95%CI为0.51 - 1.54，P = 0.68）。
TASTE试验的大型和扩展复合终点分析未显示STEMI患者PCI期间常规血栓抽吸有任何临床益处。没有证据表明血栓抽吸会增加卒中风险。
