Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289, Leipzig, Germany.
Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
Clin Res Cardiol. 2020 Oct;109(10):1223-1231. doi: 10.1007/s00392-020-01613-0. Epub 2020 Feb 6.
To investigate the long-term prognostic value of aspiration thrombectomy in conjunction with primary percutaneous coronary intervention (PCI) compared to conventional PCI in patients with non-ST-elevation myocardial infarction (NSTEMI).
In the randomized TATORT-NSTEMI (Thrombus aspiration in thrombus containing culprit lesions in non-ST-elevation myocardial infarction) trial, NSTEMI patients with thrombus containing culprit lesions were randomized to either PCI with aspiration thrombectomy or conventional PCI. The endpoint was a combination of all-cause death, reinfarction and new congestive heart failure.
From 440 patients initially randomized, outcome data were available in 432 (98.2%) patients at a median follow-up of 4.9 (interquartile range [IQR] 4.4-5.0) years. Thrombectomy was associated with a significant reduction of the combined endpoint compared to conventional PCI (19.9% vs. 30.7%, p = 0.01). This finding was primarily driven by a reduced rate of reinfarction with thrombectomy (3.4% vs. 10.3%, p = 0.01). Thrombectomy was still independently associated with the combined endpoint after multivariable adjustment (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.30-0.76, p = 0.002). Findings were consistent across all analyzed subgroups (p values for interaction all > 0.05).
In NSTEMI, thrombus aspiration is associated with favorable clinical outcome during long-term follow-up.
NCT01612312.
研究血栓抽吸联合直接经皮冠状动脉介入治疗（PCI）与常规 PCI 治疗非 ST 段抬高型心肌梗死（NSTEMI）患者的长期预后价值。
在随机 TATORT-NSTEMI（非 ST 段抬高型心肌梗死血栓含有罪犯病变中的血栓抽吸）试验中，将含有血栓的罪犯病变的 NSTEMI 患者随机分为血栓抽吸 PCI 组或常规 PCI 组。终点是全因死亡、再梗死和新发充血性心力衰竭的组合。
在最初随机分组的 440 例患者中，中位随访 4.9 年（四分位距 [IQR] 4.4-5.0）时，有 432 例（98.2%）患者获得了结局数据。与常规 PCI 相比，血栓抽吸与联合终点的显著降低相关（19.9% vs. 30.7%，p = 0.01）。这一发现主要归因于血栓抽吸组再梗死率的降低（3.4% vs. 10.3%，p = 0.01）。多变量调整后，血栓抽吸仍与联合终点独立相关（风险比 [HR] 0.47，95%置信区间 [CI] 0.30-0.76，p = 0.002）。在所有分析的亚组中，结果均一致（交互作用的 p 值均>0.05）。
在 NSTEMI 中，血栓抽吸与长期随访期间的良好临床结局相关。
NCT01612312。
