Weizman Orianne, Hauguel-Moreau Marie, Gerbaud Edouard, Cayla Guillaume, Lemesle Gilles, Ferrières Jean, Schiele François, Puymirat Etienne, Simon Tabassome, Danchin Nicolas
Cardiology Department, Ambroise-Paré University Hospital, AP-HP, 92100 Boulogne-Billancourt, France; Cardiology Department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France.
Cardiology Department, Ambroise-Paré University Hospital, AP-HP, 92100 Boulogne-Billancourt, France.
Arch Cardiovasc Dis. 2025 Jun-Jul;118(6-7):382-390. doi: 10.1016/j.acvd.2025.02.008. Epub 2025 Mar 20.
The long-term prognostic impact of thrombus aspiration (TA) in acute myocardial infarction (AMI) is unclear.
To assess the long-term prognostic impact of TA in AMI.
Data were obtained from three nationwide French surveys (FAST-MI 2005, 2010 and 2015) including consecutive patients with AMI. Long-term death rate (up to 10 years) was assessed according to use of TA in patients with AMI treated with percutaneous coronary intervention (PCI).
TA was used in 1781/9654 patients (18%; 2005, 7%; 2010, 27%; 2015, 18%), including 1546 (86.8%) with ST-segment elevation myocardial infarction. Patients who had TA were younger (61 vs. 65 years; P<0.001), mostly men (81 vs. 74%; P<0.001) and their culprit lesion was more often on the right coronary artery (40 vs. 31%; P<0.001). Crude very long-term mortality was lower with TA (25.0 vs. 32.5%; crude hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.68-0.82; P<0.001). Adjusting on a propensity score (PS) for getting TA, very long-term mortality did not differ (HR 1.03, 95% CI 0.89-1.20; P=0.67). In-hospital stroke was more frequent with TA (0.7 vs. 0.4%; P=0.04). After PS matching (two cohorts, 1430 patients in each), very long-term mortality was similar in the two PS-matched cohorts (HR 1.02, 95% CI 0.87-1.19; P=0.84). In patients with a high thrombus burden, the adjusted HR for very long-term mortality was 0.76 (95% CI 0.59-0.98; P=0.03) in favour of TA.
These routine-practice data show that TA use increased until 2010 and declined thereafter, in keeping with international guidelines. In the overall population of patients with AMI who underwent PCI, TA had no effect on long-term survival. In those with a high thrombus burden, TA was associated with improved long-term survival.
血栓抽吸术（TA）对急性心肌梗死（AMI）的长期预后影响尚不清楚。
评估TA对AMI的长期预后影响。
数据来自法国三项全国性调查（2005年、2010年和2015年的快速心肌梗死调查），纳入连续的AMI患者。根据接受经皮冠状动脉介入治疗（PCI）的AMI患者是否使用TA评估长期死亡率（长达10年）。
1781/9654例患者（18%）使用了TA（2005年为7%；2010年为27%；2015年为18%），其中1546例（86.8%）为ST段抬高型心肌梗死。接受TA治疗的患者更年轻（61岁对65岁；P<0.001），男性居多（81%对74%；P<0.001），罪犯病变更常位于右冠状动脉（40%对31%；P<0.001）。TA组的粗长期死亡率较低（25.0%对32.5%；粗风险比[HR]0.74，95%置信区间[CI]0.68 - 0.82；P<0.001）。根据接受TA的倾向评分（PS）进行调整后，长期死亡率无差异（HR 1.03，95%CI 0.89 - 1.20；P = 0.67）。TA组院内卒中更常见（0.7%对0.4%；P = 0.04）。PS匹配后（两个队列，各1430例患者），两个PS匹配队列的长期死亡率相似（HR 1.02，95%CI 0.87 - 1.19；P = 0.84）。在血栓负荷高的患者中，长期死亡率的调整后HR为0.76（95%CI 0.59 - 0.98；P = 0.03），支持TA治疗。
这些常规实践数据表明，TA的使用在2010年前增加，此后下降，符合国际指南。在接受PCI的AMI患者总体中，TA对长期生存无影响。在血栓负荷高的患者中，TA与改善长期生存相关。
