文献检索，用中文搜 PubMed

Background There is significant regional or institutional variation in the use of thrombus aspiration (TA) in patients undergoing percutaneous coronary intervention (PCI). We investigated the temporal trend in TA use and its association with clinical outcomes in acute coronary syndrome using the nationwide J-PCI (Japanese PCI) registry. Methods and Results Between 2016 and 2018, patients with acute coronary syndrome undergoing PCI (n=282 606; median age, 71.0 years; interquartile range, 62.0-79.0 years; women, 24.7%) at 1124 hospitals were stratified on the basis of whether TA was performed (TA and non-TA). The patients were subdivided according to clinical presentation (ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina). Successful PCI, defined as the achievement of TIMI (Thrombolysis in Myocardial Infarction) 3 flow, and in-hospital mortality were assessed. During the study period, 83 422 patients (29.5%) underwent TA (52.9%, 23.5%, and 5.2% for ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, respectively), and the TA implementation rate remained relatively stable throughout. Patients treated with TA had higher rate of successful PCI than non-TA (98.7% versus 97.8%; <0.001). TA was not associated with in-hospital death among patients with ST-segment-elevation myocardial infarction (adjusted odds ratio [aOR], 1.02 [95% CI, 0.94-1.12]). However, TA use was associated with higher rates of in-hospital death in patients with non-ST-segment-elevation myocardial infarction ( aOR, 1.51 [95% CI, 1.23-1.86]) or unstable angina ( aOR, 1.95 [95% CI, 1.37-2.79]). Conclusions In our retrospective analysis of the nationwide PCI registry, TA use was associated with a higher achievement of successful PCI without impairing in-hospital mortality among patients with ST-segment-elevation myocardial infarction. Nevertheless, its use should be cautioned in less-established indications (eg, non-ST-segment-elevation myocardial infarction and unstable angina).

背景

在接受经皮冠状动脉介入治疗（PCI）的患者中，血栓抽吸（TA）的使用存在显著的地域或机构差异。我们利用全国性的 J-PCI（日本 PCI）注册研究，调查了 TA 使用的时间趋势及其与急性冠状动脉综合征患者临床结局的关系。

方法和结果

在 2016 年至 2018 年间，1124 家医院共 282606 例急性冠状动脉综合征行 PCI 的患者（中位年龄 71.0 岁；四分位间距 62.0-79.0 岁；女性 24.7%），根据是否行 TA 进行分层（TA 和非-TA）。根据临床表现（ST 段抬高型心肌梗死、非 ST 段抬高型心肌梗死和不稳定型心绞痛）将患者进一步细分。评估成功的 PCI（定义为达到 TIMI（心肌梗死溶栓）3 级血流）和院内死亡率。在研究期间，83422 例患者（29.5%）接受了 TA（ST 段抬高型心肌梗死、非 ST 段抬高型心肌梗死和不稳定型心绞痛分别占 52.9%、23.5%和 5.2%），并且 TA 的实施率在整个研究期间保持相对稳定。与非-TA 相比，接受 TA 治疗的患者 PCI 成功率更高（98.7%比 97.8%；<0.001）。在 ST 段抬高型心肌梗死患者中，TA 与院内死亡无关（校正比值比[OR]，1.02[95%CI，0.94-1.12]）。然而，在非 ST 段抬高型心肌梗死或不稳定型心绞痛患者中，TA 与更高的院内死亡率相关（非 ST 段抬高型心肌梗死患者 OR，1.51[95%CI，1.23-1.86]；不稳定型心绞痛患者 OR，1.95[95%CI，1.37-2.79]）。