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【文摘发布】NEJM:血栓抽吸能改善ST段抬高心肌梗
Tone Svilaas, M.D., Pieter J. Vlaar, M.Sc., Iwan C. van der Horst, M.D., Ph.D., Gilles F.H. Diercks, M.D., Ph.D., Bart J.G.L. de Smet, M.D., Ph.D., Ad F.M. van den Heuvel, M.D., Ph.D., Rutger L. Anthonio, M.D., Ph.D., Gillian A. Jessurun, M.D., Ph.D., Eng-Shiong Tan, M.D., Albert J.H. Suurmeijer, M.D., Ph.D., and Felix Zijlstra, M.D., Ph.D.
ABSTRACT
Background Primary percutaneous coronary intervention (PCI) is effective in opening the infarct-related artery in patients with myocardial infarction with ST-segment elevation. However, the embolization of atherothrombotic debris induces microvascular obstruction and diminishes myocardial reperfusion.
Methods We performed a randomized trial assessing whether manual aspiration was superior to conventional treatment during primary PCI. A total of 1071 patients were randomly assigned to the thrombus-aspiration group or the conventional-PCI group before undergoing coronary angiography. Aspiration was considered to be successful if there was histopathological evidence of atherothrombotic material. We assessed angiographic and electrocardiographic signs of myocardial reperfusion, as well as clinical outcome. The primary end point was a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively).
Results A myocardial blush grade of 0 or 1 occurred in 17.1% of the patients in the thrombus-aspiration group and in 26.3% of those in the conventional-PCI group (P<0.001). Complete resolution of ST-segment elevation occurred in 56.6% and 44.2% of patients, respectively (P<0.001). The benefit did not show heterogeneity among the baseline levels of the prespecified covariates. At 30 days, the rate of death in patients with a myocardial blush grade of 0 or 1, 2, and 3 was 5.2%, 2.9%, and 1.0%, respectively (P=0.003), and the rate of adverse events was 14.1%, 8.8%, and 4.2%, respectively (P<0.001). Histopathological examination confirmed successful aspiration in 72.9% of patients.
Conclusions Thrombus aspiration is applicable in a large majority of patients with myocardial infarction with ST-segment elevation, and it results in better reperfusion and clinical outcomes than conventional PCI, irrespective of clinical and angiographic characteristics at baseline.
557.pdf (277.0k) Thrombus Aspiration during Primary Percutaneous Coronary Intervention
急诊冠脉介入中的血栓抽吸
ABSTRACT
摘要：
Background Primary percutaneous coronary intervention (PCI) is effective in opening the infarct-related artery in patients with myocardial infarction with ST-segment elevation. However, the embolization of atherothrombotic debris induces microvascular obstruction and diminishes myocardial reperfusion.
背景：急诊冠脉介入治疗是ST段抬高性心肌梗死治疗中开通梗死相关动脉的有效方法。然而，动脉血栓碎屑会导致微血管堵塞，减少心肌灌注。
Methods We performed a randomized trial assessing whether manual aspiration was superior to conventional treatment during primary PCI. A total of 1071 patients were randomly assigned to the thrombus-aspiration group or the conventional-PCI group before undergoing coronary angiography. Aspiration was considered to be successful if there was histopathological evidence of atherothrombotic material. We assessed angiographic and electrocardiographic signs of myocardial reperfusion, as well as clinical outcome. The primary end point was a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively).
方法：我们进行了一项随机研究评价急诊冠脉介入中采用手工血栓抽吸是否优于传统治疗方式。1071例患者在接受冠脉造影前随机分配到血栓抽吸组和传统PCI组。以组织学检查发现动脉血栓性物质作为抽吸成功的判断标准。我们采用造影和心电图指标判断心肌再灌注，同时也关注临床预后。主要终点是心肌充血分级0或1级（分别为没有或很少心肌再灌注）。
Results A myocardial blush grade of 0 or 1 occurred in 17.1% of the patients in the thrombus-aspiration group and in 26.3% of those in the conventional-PCI group (P<0.001). Complete resolution of ST-segment elevation occurred in 56.6% and 44.2% of patients, respectively (P<0.001). The benefit did not show heterogeneity among the baseline levels of the prespecified covariates. At 30 days, the rate of death in patients with a myocardial blush grade of 0 or 1, 2, and 3 was 5.2%, 2.9%, and 1.0%, respectively (P=0.003), and the rate of adverse events was 14.1%, 8.8%, and 4.2%, respectively (P<0.001). Histopathological examination confirmed successful aspiration in 72.9% of patients.
结果：心肌充血分级0或1级在血栓抽吸组和传统冠脉介入组分别为17.1％和26.3％（P<0.001）。两组ST段抬高完全恢复比例为56.6％和44.2％（P<0.001）。基线协同变量的不同并不影响患者获益。30天后，心肌充血分级为0或1级、2级、3级患者的死亡率分别为5.2％、2.9％、1.0％（P＝0.003），不良事件率分别为14.1％、8.8％、4.2％（P<0.001）。组织学检查证实72.9％的患者抽吸成功。
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作者:admin@医学,生命科学 2011-06-12 05:14
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