| Background and Objectives Coronary heart disease(CHD)has become the leading cause of death for claiming more than 70 million lives worldwide every year.In recent years,the morbidity and mortality of acute coronary syndromes(ACS),especially acute ST-segment elevation myocardial infarction(STEMI)in China are both increasing rapidly year by year.STEMI is an acute myocardial ischemic necrosis,thus its principle of treatment requires opening of the infarct-related artery(IRA)as soon as possible to achieve myocardial reperfusion.Currently,myocardial mechanical reperfusion in patients with STEMI can be achieved in time by primary percutaneous coronary intervention(PCI).But for patients who have an occluded epicardial vessel,balloon angioplasty and stent implantation might cause disruption of the frail thrombus containing lesions which would lead to the occurrence of myocardial microcirculatory obstruction and no-reflow phenomenon.Certain studies have shown that thrombus aspiration during primary angioplasty can effectively prevent many adverse events such as the occurrence of no-reflow phenomenon and distal embolization of atherothrombotic material.However,other studies have shown that the application of thrombus aspiration in PCI does not significantly improve the long-term prognosis of patients with STEMI.This study aimed to evaluate the clinical effects of thrombus aspiration in PCI for patients with STEMI.Methods Clinical data of PCI for 101 consecutive patients with STEMI from September 2015 to February 2016 in Cardiovascular Internal Medicine Department and Emergency Department,Xijing Hospital were retrospectively analyzed.These patients were divided into two groups: thrombus aspiration group(n=51)and PCI alone group(n=50).STEMI patients without thrombus aspiration by the Export Catheter before balloon pre-dilation or stent implantation in PCI were chosen as a control group.The two groups were compared in characteristics at baseline(sex,age,body mass index(BMI),blood pressure,heart rate,left ventricular ejection fraction(LVEF),the level of serum low density lipoprotein-cholesterol(LDL-C),cardiac function classification,anamneses,et al)and during and after procedures(thrombolysis in myocardial infarction(TIMI)flow grade,TIMI myocardial perfusion grade(TMPG),myocardial blush grade(MBG),ST-segment resolution(STR),et al).The incidences of the primary and secondary outcomes(including cardiovascular death,recurrent myocardial infarction,cardiogenic shock,New York Heart Association(NYHA)class Ⅳ heart failure,stent thrombosis and target vessel revascularization(TVR),et al)were also comparatively analyzed between the two groups within 1-year follow-up.Then the statistics were divided into three subgroups based on patients’ age,BMI and myocardial ischemia time,and the incidences of major adverse cardiac events(MACE)after procedures of the patients of thrombus aspiration group and PCI alone group were further analyzed within the subgroups.And Student’s t-test,chi-square test,nonparametric test and survival analysis were conducted with SPSS software.Results1.There were no significant differences between patients of thrombus aspiration group and PCI alone group in characteristics at baseline(P>0.05)except the history of hypertension(60.8%: 40.0%,P=0.037)and myocardial infarction(2.0%: 14.0%,P=0.031).2.There were also no significant differences between patients of thrombus aspiration group and PCI alone group in characteristics during and after procedures(P>0.05)except the use of glycoprotein Ⅱb/Ⅲa antagonists(Tirofiban)(66.7%: 28%,P<0.001).3.At 368.99±5.98 days follow-up,the primary outcome was 15.7% in thrombus aspiration group versus 20.0% in PCI alone group,respectively(odds ratio(OR)in thrombus aspiration group,0.81,95% confidence interval(CI),0.32~2.06,P=0.660);the secondary outcome was 19.6% in thrombus aspiration group versus 22.0% in PCI alone group,respectively(OR=0.93,95% CI(0.39~2.18),P=0.859).There were no significant differences between the two groups in the primary and secondary outcomes at 1-year follow-up.4.Subgroup Analysis1)In the subgroup of patients older than 65 years,the primary outcome(50.0%with thrombus aspiration versus 28.6% with PCI alone,OR=2.32,95% CI(0.78~6.92),P=0.133)and the secondary outcome(57.1% with thrombus aspiration versus 23.8% with PCI alone,OR=3.03,95% CI(0.98~9.31),P=0.053)were similar.And in the subgroup of patients younger than 65 years,the primary outcome(2.7% with thrombus aspiration versus 13.8% with PCI alone,OR=0.19,95% CI(0.02~1.69),P=0.188)and the secondary outcome(5.4% with thrombus aspiration versus 17.2% with PCI alone,OR=0.31,95% CI(0.06~1.58),P=0.158)were also similar.2)In the subgroup of patients with BMI≥24,the primary outcome(13.3% with thrombus aspiration versus 18.9% with PCI alone,OR=0.72,95% CI(0.24~2.15),P=0.559)and the secondary outcome(17.8% with thrombus aspiration versus 18.9% with PCI alone,OR=0.97,95% CI(0.35~2.66),P=0.946)were similar.And in the subgroup of patients with BMI<24,the primary and the secondary outcome(both are 33.3% with thrombus aspiration versus 23.1% with PCI alone,OR=1.62,95% CI(0.27~9.74),P=0.598)were also similar.3)In the subgroup of patients with longer myocardial ischemia time(≥180 mintues),the primary outcome(13.0% with thrombus aspiration versus 22.9% with PCI alone,OR=0.57,95% CI(0.15~2.16),P=0.409)and the secondary outcome(17.4% with thrombus aspiration versus 22.9% with PCI alone,OR=0.77,95% CI(0.23~2.57),P=0.673)were similar.And in the subgroup of patients with shorter myocardial ischemia time(<180 mintues),the primary outcome(17.9% with thrombus aspiration versus 13.3%with PCI alone,OR=1.45,95% CI(0.28~7.48),P=0.657)and the secondary outcome(21.4% with thrombus aspiration versus 13.3% with PCI alone,OR=1.76,95% CI(0.36~8.73),P=0.489)were also similar.Conclusions1.The application of thrombus aspiration in PCI for patients with STEMI would not prolong the duration of procedures,nor would the timing of opening of IRA be adversely affected.2.The application of thrombus aspiration in PCI for patients with STEMI cannot effectively improve the myocardial reperfusion,nor can the incidence of slow-reflow and no-reflow phenomenon be reduced.3.The application of thrombus aspiration in PCI for patients with STEMI cannot significantly reduce the risk of MACE after procedures,nor can the long-term prognosis be distinctively improved.4.The application of thrombus aspiration in PCI for patients older than 65 years not only cannot effectively improve the myocardial reperfusion,but also shows the trend of increasing the incidence of long-term MACE.But for patients younger than 65 years,thrombus aspiration may reflect some protective effects by showing the trend of reducing the incidence of long-term MACE.However,these trends are neither statistically significant. |
PDF Full Text Request