Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy.
Department of Biochemistry, Biophysics and General Pathology, University of Campania "Luigi Vanvitelli", Naples, Italy.
Cardiovasc Diabetol. 2018 Nov 29;17(1):152. doi: 10.1186/s12933-018-0795-8.
We evaluate whether the thrombus aspiration (TA) before primary percutaneous coronary intervention (PPCI) may improve STEMI outcomes in hyperglycemic patients.
The management of hyperglycemic patients during STEMI is unclear.
We undertook an observational cohort study of 3166 first STEMI. Patients were grouped on the basis of whether they received TA or not. Moreover, among these patients we selected a subgroup of STEMI patients with hyperglycemia during the event (glycaemia > 140 mg/dl). The endpoint at 1 year included all-cause mortality, cardiac mortality and re-hospitalization for coronary disease, heart failure and stroke.
One-thousand STEMI patients undergoing PPCI to plus TA (TA-group) and 1504 STEMI patients treated with PPCI alone (no-TA group) completed the study. In overall study-population, Kaplan-Meier-analysis demonstrated no significant difference in mortality rates between patients with and without TA (P = 0.065). After multivariate Cox-analysis (HR: 0.94, 95% CI 0.641-1.383) and the addition of propensity matching (HR: 0.86 95% CI 0.412-1.798) TA was still not associated with decreased mortality. By contrast, in hyperglycemic subgroup STEMI patients (TA-group, n = 331; no-TA group, n = 566), Kaplan-Meier-analysis demonstrated a significantly lower mortality (P = 0.019) in TA-group than the no-TA group. After multivariate Cox-analysis (HR: 0.64, 95% CI 0.379-0.963) and the addition of propensity matching (HR: 0.54, 95% CI 0.294-0.984) TA was still associated with decreased mortality.
TA was not associated with lower mortality in PPCI for STEMI when used in our large all-comer cohort. Conversely, TA during PPCI for STEMI reduces clinical outcomes in hyperglycemic patients. Trial registration NCT02817542. 25th, June 2016.
我们评估在直接经皮冠状动脉介入治疗（PPCI）前进行血栓抽吸（TA）是否可以改善高血糖患者的 ST 段抬高型心肌梗死（STEMI）结局。
STEMI 期间高血糖患者的处理方法尚不清楚。
我们对 3166 例首次 STEMI 进行了观察性队列研究。根据是否接受 TA 将患者分为两组。此外，我们还在这些患者中选择了一个 STEMI 伴高血糖亚组（血糖＞140mg/dl）。1 年时的终点包括全因死亡率、心脏死亡率以及因冠心病、心力衰竭和中风再次住院。
1000 例接受 PPCI 加 TA（TA 组）和 1504 例接受单纯 PPCI（无 TA 组）的 STEMI 患者完成了研究。在整个研究人群中，Kaplan-Meier 分析显示接受和不接受 TA 的患者死亡率之间无显著差异（P=0.065）。多变量 Cox 分析（HR：0.94，95%CI 0.641-1.383）和倾向匹配后（HR：0.86，95%CI 0.412-1.798），TA 与死亡率降低无关。相比之下，在高血糖亚组 STEMI 患者（TA 组，n=331；无 TA 组，n=566）中，TA 组的死亡率显著低于无 TA 组（P=0.019）。多变量 Cox 分析（HR：0.64，95%CI 0.379-0.963）和倾向匹配后（HR：0.54，95%CI 0.294-0.984），TA 仍与死亡率降低相关。
在我们的大型全人群队列中，直接经皮冠状动脉介入治疗（PPCI）时使用 TA 与 STEMI 患者的死亡率降低无关。相反，在 PPCI 治疗 STEMI 时进行 TA 可降低高血糖患者的临床结局。试验注册 NCT02817542。2016 年 6 月 25 日。
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