Sherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada.
Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada.
EuroIntervention. 2023 Aug 7;19(5):e394-e401. doi: 10.4244/EIJ-D-23-00112.
The optimal strategy to prevent no-reflow in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) is unknown.
We aimed to examine the effect of thrombectomy on the outcome of no-reflow in key subgroups and the adverse clinical outcomes associated with no-reflow.
We performed a post hoc analysis of the TOTAL Trial, a randomised trial of 10,732 patients comparing thrombectomy versus PCI alone. This analysis utilised the angiographic data of 1,800 randomly selected patients.
No-reflow was diagnosed in 196 of 1,800 eligible patients (10.9%). No-reflow occurred in 95/891 (10.7%) patients randomised to thrombectomy compared with 101/909 (11.1%) in the PCI-alone arm (odds ratio [OR] 0.95, 95% confidence interval [CI]: 0.71-1.28; p-value=0.76). In the subgroup of patients who underwent direct stenting, those randomised to thrombectomy compared with PCI alone experienced less no-reflow (19/371 [5.1%] vs 21/216 [9.7%], OR 0.50, 95% CI: 0.26-0.96). In patients who did not undergo direct stenting, there was no difference between the groups (64/504 [12.7%] vs 75/686 [10.9%)], OR 1.18, 95% CI: 0.82-1.69; interaction p-value=0.02). No-reflow patients had a significantly increased risk of experiencing the primary composite outcome (cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA Class IV heart failure) at 1 year (adjusted hazard ratio 1.70, 95% CI: 1.13-2.56; p-value=0.01).
In patients with STEMI treated by PCI, thrombectomy did not reduce no-reflow in all patients but may be synergistic with direct stenting. No-reflow is associated with increased adverse clinical outcomes.
ST 段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）中预防无复流的最佳策略尚不清楚。
我们旨在研究血栓切除术对关键亚组无复流结局的影响，以及无复流相关的不良临床结局。
我们对 TOTAL 试验进行了事后分析，该试验是一项比较血栓切除术与单独 PCI 的 10732 例患者的随机试验。该分析利用了 1800 名随机入选患者的血管造影数据。
在 1800 名符合条件的患者中，196 名（10.9%）诊断为无复流。在随机分至血栓切除术组的 891 例患者中，无复流发生于 95 例（10.7%），而在单独 PCI 组的 909 例患者中，无复流发生于 101 例（11.1%）（比值比 [OR] 0.95，95%置信区间 [CI]：0.71-1.28；p 值=0.76）。在直接支架置入的亚组患者中，与单独 PCI 相比，随机分至血栓切除术组的患者无复流发生率较低（371 例患者中有 19 例[5.1%] vs 216 例患者中有 21 例[9.7%]，OR 0.50，95% CI：0.26-0.96）。在未行直接支架置入的患者中，两组间无差异（504 例患者中有 64 例[12.7%] vs 686 例患者中有 75 例[10.9%]），OR 1.18，95% CI：0.82-1.69；交互 p 值=0.02）。无复流患者在 1 年时发生主要复合结局（心血管死亡、再发心肌梗死、心源性休克或 NYHA 心功能 IV 级心力衰竭）的风险显著增加（校正后风险比 1.70，95% CI：1.13-2.56；p 值=0.01）。
在接受 PCI 治疗的 STEMI 患者中，血栓切除术并未降低所有患者的无复流，但可能与直接支架置入具有协同作用。无复流与不良临床结局增加相关。
