Zhang Yan, Peng Li, Fan Yong-Yan, Lu Cai-Yi
Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
J Geriatr Cardiol. 2016 May;13(4):344-54. doi: 10.11909/j.issn.1671-5411.2016.04.018.
The clinical efficacy and safety of adjunctive thrombus aspiration (TA) in patients with ST-segment elevation myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) remain controversial.
Twenty five eligible randomized controlled trials were included to compare the use of thrombus aspiration (TA) with PCI and PCI-only for STEMI. The primary endpoint was all-cause mortality and death. The secondary endpoints were major adverse cardiac events (MACE), recurrent infarction (RI), target vessel revascularization (TVR), stent thrombosis (ST), perfusion surrogate markers and stroke.
TIMI flow grade 3 and MBG 2-3 were significantly increased in the TA plus PCI arm compared with the PCI-only arm [relative risk (RR): 1.05, 95% confidence intervals (CI): 1.02-1.09, P = 0.004] and (RR: 1.68, 95% CI: 1.40-2.00, P < 0.001), respectively. There were no significant differences in all-cause mortality, MACEs, TVR and ST rates between the two groups. The RI rate was lower in the TA plus PCI arm than that in the PCI-only arm with short-term follow-up duration (RR: 0.60, 95% CI: 0.38-0.96, P = 0.03), but there was no significant difference in RI incidence over the medium- or long-term follow-up periods (RR: 1.00, 95% CI: 0.77-1.29, P = 0.98), and (RR: 0.96, 95% CI: 0.81-1.15, P = 0.69), respectively. There were statistically significant differences in the rates of crude stroke and stroke over the medium- or long-term follow-up periods and the crude stroke rate in the TA plus PCI (RR: 1.60, 95% CI: 1.08-2.38, P = 0.02) and (RR: 1.43, 95% CI: 1.03-1.98, P = 0.03), respectively; this was not observed between the two arms during the short-term follow-up period (RR: 1.47, 95% CI: 0.97-2.21, P = 0.07).
Routine TA-assisted PCI in STEMI patients can improve myocardial reperfusion and get limited benefits related to the clinical endpoints, which may be associated with stroke risk.
在经皮冠状动脉介入治疗（PCI）期间，辅助血栓抽吸（TA）用于ST段抬高型心肌梗死（STEMI）患者的临床疗效和安全性仍存在争议。
纳入25项符合条件的随机对照试验，比较血栓抽吸（TA）联合PCI与单纯PCI用于STEMI的情况。主要终点是全因死亡率和死亡。次要终点是主要不良心脏事件（MACE）、再发梗死（RI）、靶血管血运重建（TVR）、支架血栓形成（ST）、灌注替代标志物和卒中。
与单纯PCI组相比，TA联合PCI组的TIMI血流3级和心肌梗死溶栓试验（TIMI）心肌灌注分级（MBG）2 - 3级显著增加，相对危险度（RR）分别为1.05，95%置信区间（CI）：1.02 - 1.09，P = 0.004]和（RR：1.68，95% CI：1.40 - 2.00，P < 0.001）。两组在全因死亡率、MACE、TVR和ST发生率方面无显著差异。短期随访期间，TA联合PCI组的RI发生率低于单纯PCI组（RR：0.60，95% CI：0.38 - 0.96，P = 0.03），但在中长期随访期内RI发生率无显著差异，相对危险度（RR）分别为1.00，95% CI：0.77 - 1.29，P = 0.98）和（RR：0.96，95% CI：0.81 - 1.15，P = 0.69）。在中长期随访期内，TA联合PCI组的粗卒中发生率和卒中发生率以及粗卒中发生率存在统计学显著差异，相对危险度（RR）分别为1.60，95% CI：1.08 - 2.38，P = 0.02）和（RR：1.43，95% CI：1.03 - 1.98，P = 0.03）；在短期随访期内两组未观察到这种差异（RR：1.47，95% CI：0.97 - 2.21，P = 0.07）。
STEMI患者常规TA辅助PCI可改善心肌再灌注，并在临床终点方面获得有限益处，这可能与卒中风险相关。
