Perera Dhanuka, Rathod Krishnaraj S, Guttmann Oliver, Beirne Anne-Marie, O'Mahony Constantinos, Weerackody Roshan, Baumbach Andreas, Mathur Anthony, Wragg Andrew, Jones Daniel A
Barts Heart Centre, St. Bartholomews Hospital West Smithfield, London EC1A 7BE, UK.
Am J Cardiovasc Dis. 2020 Dec 15;10(5):548-556. eCollection 2020.
Recent studies have suggested that the routine use of aspiration thrombectomy catheters during primary percutaneous coronary intervention (PCI) do not result in improved mortality and may be associated with an increased stroke rate. This study sought to investigate this hypothesis.
This was an observational study analysing data from a prospective database of 6366 patients undergoing primary PCI between August 2003 and May 2015 at a UK cardiac centre. Patients' details were collected from the hospital electronic database. Primary outcome was thirty-day stroke rates.
3989 (62.7%) patients underwent PCI alone and 2,377 (37.3%) patients underwent PCI with adjuctive thrombus aspiration. PCI alone group had an older demographic (63 (± 14) years vs 60.7 (± 14)), a lower proportion of male participants 75% vs 79% (P=0.001) and cardiovascular risk factors such as hypertension 22.4% vs 25.3% (P=0.007), hypercholesterolemia 18.5% vs 22.6% (P<0.0001) and a history of smoking 33.5% vs 44.3% (P<0.0001). Thrombus aspiration was associated with a higher 30-day stroke rate [16 (0.7%) vs 11 (0.3%) (HR 2.51; 95% CI 1.03-6.08, P 0.03). Multivariate analysis suggested that this increased risk of stroke was maintained following adjustment for confounders (HR: 1.86; 95% CI 1.02-4.38). There was 379 deaths of which 114 (4.8%) were in the thrombus aspiration cohort vs 265 (6.6%) in PCI only cohort over the follow-up period (60 months). This resulted in a significantly lower rate of all-cause-mortality HR 0.70 (95% CI 0.52-0.94; P 0.02). There was no statistically significant difference in observed myocardial infarction rates HR 0.76 (95% CI 0.47-1.23; P 0.27) and the rates of unscheduled revascularisations HR 0.70 (95% CI 0.43-1.13; P 0.14) between the two groups.
Our data series of STEMI patients, suggest that routine thrombus aspiration during primary PCI is associated with a significantly higher stroke, rate however, thrombus aspiration reduced mortality rate. This is consistent with current guidelines which don't recommend the routine use of thrombus aspiration for primary PCI. A possible mortality reduction in patients with high thrombus grades was seen which may warrant further study.
近期研究表明，在直接经皮冠状动脉介入治疗（PCI）期间常规使用血栓抽吸导管并不能提高生存率，且可能与中风发生率增加有关。本研究旨在探究这一假说。
这是一项观察性研究，分析了2003年8月至2015年5月期间在英国一家心脏中心接受直接PCI的6366例患者的前瞻性数据库中的数据。患者详细信息从医院电子数据库中收集。主要结局指标为30天中风发生率。
3989例（62.7%）患者仅接受了PCI，2377例（37.3%）患者接受了PCI联合血栓抽吸治疗。仅接受PCI组患者年龄更大（63（±14）岁 vs 60.7（±14）岁），男性参与者比例更低（75% vs 79%，P = 0.001），心血管危险因素如高血压（22.4% vs 25.3%，P = 0.007）、高胆固醇血症（18.5% vs 22.6%，P < 0.0001）和吸烟史（33.5% vs 44.3%，P < 0.0001）。血栓抽吸与30天更高的中风发生率相关[16例（0.7%） vs 11例（0.3%）（风险比2.51；95%置信区间1.03 - 6.08，P = 0.03）。多变量分析表明，在对混杂因素进行校正后，中风风险增加仍然存在（风险比：1.86；95%置信区间1.02 - 4.38）。在随访期（60个月）内共有379例死亡，其中血栓抽吸队列中有114例（4.8%）死亡，而仅接受PCI队列中有265例（6.6%）死亡。这导致全因死亡率显著降低，风险比为0.70（95%置信区间0.52 - 0.94；P = 0.02）。两组间观察到的心肌梗死发生率（风险比0.76；95%置信区间0.47 - 1.23；P = 0.27）和非计划血管重建率（风险比0.70；95%置信区间0.43 - 1.13；P = 0.14）无统计学显著差异。
我们关于ST段抬高型心肌梗死（STEMI）患者的数据系列表明，直接PCI期间常规血栓抽吸与显著更高的中风发生率相关，然而，血栓抽吸降低了死亡率。这与当前不推荐在直接PCI中常规使用血栓抽吸的指南一致。在高血栓分级患者中观察到可能的死亡率降低，这可能值得进一步研究。
