Clinical impact of thrombus aspiration on in-hospital mortality in each culprit lesion in the setting of ST-segment elevation myocardial infarction
Clinical impact of thrombus aspiration on in-hospital mortality in each culprit lesion in the setting of ST-segment elevation myocardial infarction
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DOI：
10.1007/s00380-018-1171-z
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发表时间：
2018-10-01
影响因子：
1.5
通讯作者：
Takayama, Morimasa
中科院分区：
文献类型：
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作者：
Higuchi, Satoshi;Suzuki, Makoto;Takayama, Morimasa
最近的随机临床试验质疑血栓抽吸术(TA)治疗ST段抬高性心肌梗死(STEMI)的临床益处。关于TA的真实数据以及TA对各种罪魁祸首病变的疗效还没有得到充分的评估。本研究的主要目的是评估TA的临床影响是否依赖于STEMI环境中的罪魁祸首病变。我们在2010至2014年间对东京冠状动脉护理单位网络登记处进行了调查，这是一项前瞻性队列研究，包括10,232名STEMI患者。住院死亡538例(5.3%)。接受TA的患者比未接受TA的患者更容易观察到心肌梗死血流的溶栓改善(87%比80%；p<；0.001)。单因素Logistic回归分析显示，TA与较低的住院死亡率相关[优势比(OR)，0.80；95%可信区间(CI)，0.66~0.96；p=0.016]。经多因素Logistic回归分析，差异无统计学意义(OR0.95；95%CI0.71~1.17；p=0.355)。仅左回旋支病变的TA与较好的预后相关(OR0.38；95%CI0.21~0.72；p=0.003)。调整后效应仍然存在(OR0.50；95%CI0.25-0.99；p=0.049)，但经反概率加权分析后减弱(OR0.97；95%CI0.93-0.99；p=0.048)。根据在一大批日本队列中的研究结果，未观察到TA对住院死亡率的预后益处。TA对Lcx损害的影响微乎其微且有限。因此，日本STEMI患者不推荐使用TA。
Recent randomized clinical trials have questioned the clinical benefits of thrombus aspiration (TA) in ST-segment elevation myocardial infarction (STEMI). Real-world data on TA and the efficacy of TA for various culprit lesions have not been sufficiently evaluated. This study mainly aimed to evaluate whether the clinical impact of TA depends on culprit lesions in the setting of STEMI. We surveyed the Tokyo Coronary Care Unit Network Registry, a prospective cohort study, between 2010 and 2014, which included 10,232 patients with STEMI. In-hospital deaths occurred in 538 patients (5.3%). Improved Thrombolysis in Myocardial Infarction flow was more frequently observed in patients who underwent TA than in those who did not (87 vs. 80%; p < 0.001). Univariate logistic regression analysis revealed that TA was associated with a lower in-hospital mortality rate [odds ratio (OR), 0.80; 95% confidential interval (CI), 0.66-0.96; p = 0.016]. However, the difference was not significant after multivariate logistic regression analysis (OR 0.95; 95% CI 0.71-1.17; p = 0.355). Only TA for the left circumflex (LCx) lesions was associated with a better prognosis (OR 0.38; 95% CI 0.21-0.72; p = 0.003). The effect persisted after adjustment (OR 0.50; 95% CI 0.25-0.99; p = 0.049) but was attenuated after analysis using inverse probability weighting (OR 0.97; 95% CI 0.93-0.99; p = 0.048). On the basis of the findings in a large Japanese cohort, a prognostic benefit of TA on in-hospital mortality was not observed. The effect of TA on the LCx lesionswas marginally significant and limited. Therefore, TA is not recommended in Japanese patients with STEMI.