Tung Ying-Chang, See Lai-Chu, Chang Shu-Hao, Tu Hui-Tzu, Chan Yi-Hsin, Chang Chi-Jen
Cardiovascular Department, Linkou Chang Gung Memorial Hospital.
College of Medicine.
Medicine (Baltimore). 2020 May 29;99(22):e19590. doi: 10.1097/MD.0000000000019590.
Few data exist on the clinical outcomes of selective aspiration thrombectomy during primary percutaneous coronary intervention (PPCI).This was a nationwide retrospective cohort study. Patients who were diagnosed with ST-elevation myocardial infarction (STEMI) and received primary percutaneous coronary intervention (PCI) from July 2009 to December 2011 were identified from the National Health Insurance Research Database of Taiwan. Propensity score weighting was used to balance the covariates between the 2 study groups. The primary endpoints were all-cause mortality and stroke during hospitalization and at 30 days and 1 year of follow-up. Subgroup analyses were performed based on the hospital and physician volume of primary PCI.A total of 9100 ST-elevation myocardial infarction patients (29.4% of patients receiving aspiration thrombectomy and conventional PPCI vs 70.6% receiving PPCI alone) were identified. The incidence rates of all-cause mortality were comparable between the 2 groups during hospitalization (21.0 vs 27.37/100 person-months; P = .29) and 1-year follow-up (0.81 vs 1.26/100 person-months; P = .85). There were no significant differences in the stroke rates between the 2 groups during hospitalization (1.1 vs 2.34/100 person-months; P = .3) and 1-year follow-up (0.09 vs 0.15/100 person-months; P = .85). For the patients who survived to discharge, the post-discharge 1-year mortality was lower in the aspiration thrombectomy group of patients in whom the procedures were performed by physicians with a high volume of PPCI (hazard ratio: 0.47; 95% confidence interval: 0.24-0.94; P = .03).In this nationwide cohort study, selective aspiration thrombectomy at the operation's discretion had a comparable mortality rate compared with PCI alone and did not increase the risk of stroke. In the patients treated by physicians with a high volume of PPCI, aspiration thrombectomy appeared to have a beneficial effect on post-discharge survival at 1 year.
关于在直接经皮冠状动脉介入治疗（PPCI）期间进行选择性血栓抽吸术的临床结局，现有数据较少。这是一项全国性回顾性队列研究。从台湾国民健康保险研究数据库中识别出2009年7月至2011年12月期间被诊断为ST段抬高型心肌梗死（STEMI）并接受直接经皮冠状动脉介入治疗（PCI）的患者。采用倾向评分加权法来平衡两个研究组之间的协变量。主要终点为住院期间、30天及1年随访时的全因死亡率和卒中。根据直接PCI的医院和医生工作量进行亚组分析。共识别出9100例ST段抬高型心肌梗死患者（29.4%的患者接受血栓抽吸术和传统PPCI，70.6%的患者仅接受PPCI）。两组在住院期间（21.0对27.37/100人月；P = 0.29）和1年随访时（0.81对1.26/100人月；P = 0.85）的全因死亡率发生率相当。两组在住院期间（1.1对2.34/100人月；P = 0.3）和1年随访时（0.09对0.15/有人月；P = 0.85）的卒中发生率无显著差异。对于存活至出院的患者，在由直接PCI手术量大的医生进行手术的血栓抽吸术组患者中，出院后1年死亡率较低（风险比：0.47；95%置信区间：0.24 - 0.94；P = 0.03）。在这项全国性队列研究中，酌情进行的选择性血栓抽吸术与单纯PCI相比死亡率相当，且未增加卒中风险。在由直接PCI手术量大的医生治疗的患者中，血栓抽吸术似乎对出院后1年生存率有有益影响。
