Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, Barat, 11420, Indonesia.
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
BMC Cardiovasc Disord. 2020 Mar 31;20(1):153. doi: 10.1186/s12872-020-01432-1.
Studies have not demonstrated consistent outcomes following thrombus aspiration in Primary Percutaneous Coronary Intervention (PPCI). We investigated the relationship between thrombus aspiration and microvascular obstruction as measured using Index of Microcirculatory Resistance (IMR) immediately following PPCI and Left Ventricle Function Improvement measured using Global Longitudinal Strain (GLS) six months following PPCI. Our aim is to determine microvascular obstruction and left ventricle function improvement six months following thrombus aspiration during PPCI.
This was a single-center, observational, prospective non-randomized study involving 45 patients with thrombus score 4-5 (defined as high thrombus burden) and Thrombolysis in Myocardial Infarction (TIMI) flow of 0-2 who subsequently underwent PPCI. Thrombus aspiration was conducted based on physician discretion. The IMR was measured immediately following the procedure. All patients underwent echocardiography to measure GLS at 24 h, 3 months and 6 months following PPCI.
Thirty-three (73%) patients underwent thrombus aspiration during PPCI and twelve (27%) patients underwent the conventional PPCI. No significant difference in IMR was found between the group that underwent thrombus aspiration and the group that underwent conventional PCI (51.9 ± 41.5 vs 47.1 ± 35.6 p = 0.723). TIMI flow after PPCI was worse in thrombus aspiration group (OR 5.2 [1.2-23.2], p = 0.041). There was no difference in GLS between two groups at 6-month follow-up (- 13.0 ± 3.4 vs - 12.8 ± 4.6, p = 0.912).
This study indicates no benefit of thrombus aspiration during PPCI in reducing either microvascular obstruction or left ventricular function at 6-month follow-up for patients with high thrombus burden. Nevertheless, further studies are required before definite conclusions can be made.
在经皮冠状动脉介入治疗（PPCI）中血栓抽吸的结果尚未得到一致证实。我们研究了即刻经 PPCI 后使用微血管阻力指数（IMR）测量的血栓抽吸与微血管阻塞之间的关系，以及 6 个月时使用整体纵向应变（GLS）测量的左心室功能改善之间的关系。我们的目的是确定 PPCI 期间血栓抽吸后 6 个月的微血管阻塞和左心室功能改善。
这是一项单中心、观察性、前瞻性非随机研究，纳入了 45 名血栓评分 4-5 分（定义为高血栓负荷）和血栓溶解心肌梗死（TIMI）血流 0-2 分的患者，随后接受了 PPCI。根据医生的判断进行血栓抽吸。即刻测量术毕 IMR。所有患者均在 PPCI 后 24 小时、3 个月和 6 个月行超声心动图检查测量 GLS。
33 名（73%）患者在 PPCI 期间进行了血栓抽吸，12 名（27%）患者进行了常规 PPCI。在接受血栓抽吸和常规 PCI 的两组之间，IMR 无显著差异（51.9±41.5 vs 47.1±35.6，p=0.723）。PPCI 后 TIMI 血流在血栓抽吸组更差（比值比 5.2[1.2-23.2]，p=0.041）。两组 6 个月时 GLS 无差异（-13.0±3.4 vs -12.8±4.6，p=0.912）。
这项研究表明，对于高血栓负荷的患者，在 PPCI 期间进行血栓抽吸并不能降低微血管阻塞或左心室功能，在 6 个月随访时也没有获益。然而，在得出明确结论之前，还需要进一步的研究。
