University of Campania "Vanvitelli", Piazza Miraglia, Naples, Italy.
ASL Avellino, Avellino, Italy.
Aging Clin Exp Res. 2021 Nov;33(11):3081-3089. doi: 10.1007/s40520-021-01848-5. Epub 2021 Apr 4.
Despite primary percutaneous coronary intervention (PPCI) is generally considered the best therapy in older frail adults with ST-segment elevation myocardial infarction (STEMI), the incidence of re-hospitalization for cardiovascular diseases remains significant in these patients.
We hypothesized that thrombus aspiration (TA) before PPCI could be a useful treatment for reducing mortality and rehospitalizations in frail patients undergoing PPCI for STEMI.
We conducted a study comparing PPCI alone vs TA + PPCI in frail STEMI patients. We examined a cohort of consecutive frail patients aged ≥ 65 years with first STEMI treated with PPCI between February 2008 and July 2015 at the Department of Cardiology of the "Cardarelli" Hospital in Naples, Italy.
The study was completed by 389 patients (PPCI: 195, TA + PPCI: 194). At 1-month follow-up, the rate of death from any cause was 7.0% in patients treated with PPCI alone vs 3.0% in patients treated with TA + PPCI (p 0.036), whereas death from cardiovascular causes was 6.0% in the PPCI group vs 3.0% in the TA + PPCI group (p 0.028). Equally important, the rate of re-hospitalization due to heart failure was 7.5% in the PPCI group vs 4.0% in TA + PPCI group (p 0.025) and the rate of re-hospitalization due to acute coronary syndrome was 10.0% in the PPCI group vs 4.5% in the TA + PPCI group (p 0.016).
These results indicate the importance of TA in the treatment of STEMI in a group of high-risk patients such as elderly with frailty.
尽管经皮冠状动脉介入治疗（PPCI）通常被认为是 ST 段抬高型心肌梗死（STEMI）老年虚弱患者的最佳治疗方法，但这些患者的心血管疾病再住院率仍然很高。
我们假设在接受 PPCI 治疗的虚弱患者中，在 PPCI 之前进行血栓抽吸（TA）可能是降低死亡率和再住院率的有用治疗方法。
我们进行了一项比较单独 PPCI 与 TA+PPCI 治疗虚弱 STEMI 患者的研究。我们检查了意大利那不勒斯“Cardarelli”医院心内科 2008 年 2 月至 2015 年 7 月期间连续接受 PPCI 治疗的年龄≥65 岁的虚弱首次 STEMI 患者队列。
389 例患者完成了研究（PPCI：195 例，TA+PPCI：194 例）。在 1 个月随访时，单独接受 PPCI 治疗的患者的任何原因死亡率为 7.0%，而接受 TA+PPCI 治疗的患者的死亡率为 3.0%（p=0.036），而心血管原因死亡率在 PPCI 组为 6.0%，在 TA+PPCI 组为 3.0%（p=0.028）。同样重要的是，心力衰竭再住院率在 PPCI 组为 7.5%，在 TA+PPCI 组为 4.0%（p=0.025），急性冠状动脉综合征再住院率在 PPCI 组为 10.0%，在 TA+PPCI 组为 4.5%（p=0.016）。
这些结果表明，在老年虚弱等高危患者中，TA 在 STEMI 治疗中的重要性。
