Presence of Older Thrombus Is an Independent Predictor of Long-Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Thrombus Aspiration During Primary Percutaneous Coronary Intervention
Presence of Older Thrombus Is an Independent Predictor of Long-Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Thrombus Aspiration During Primary Percutaneous Coronary Intervention
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DOI：
10.1161/circulationaha.108.780734
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发表时间：
2008-10-28
期刊：
影响因子：
37.8
通讯作者：
de Winter, Robbert J.
中科院分区：
文献类型：
--
作者：
Kramer, Miranda C. A.;van der Wal, Allard C.;de Winter, Robbert J.
背景-ST段抬高型心肌梗死患者在直接经皮冠状动脉介入治疗中经常使用常规血栓抽吸来预防远端栓塞。最近，发表了临床获益的证据。50%的ST段抬高型心肌梗死患者发病1天。这一观察结果表明，斑块破裂和冠状动脉闭塞在时间上是明显分开的。在本研究中，我们与存在新鲜与老年血栓与长期mortality.Methods和Results-Thrombus抽吸进行了1315例患者与3个设备（救援，出口，和Proxis）的直接经皮冠状动脉介入治疗。将抽吸的材料固定在福尔马林中并进行组织病理学处理。如果可能，将血栓年龄分类为仅新鲜（1天）。我们在552例患者中发现了新鲜血栓，在372例患者中发现了陈旧性血栓。与新鲜血栓患者（7.4%）相比，陈旧血栓患者（16.0%）4年全因死亡率的累积Kaplan-Meier估计值显著更高，风险比为1.82（95%置信区间，1.17 - 2.85; P=0.008）。多变量分析表明，除其他已确定的预测因素外，陈旧性血栓的存在是独立的预测因素（风险比，1.83; 95%置信区间，1.14至2.93;结论：我们的研究表明，除了其他已确定的预测因素外，是直接经皮冠状动脉介入治疗期间接受血栓抽吸治疗的ST段抬高型心肌梗死患者长期死亡率的独立预测因素。（循环。2008; 118：1810-1816.）
Background-Routine thrombus aspiration is frequently used during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction to prevent distal embolization. Recently, evidence of clinical benefit was published. In 50% of the ST-elevation myocardial infarction patients with an onset of symptoms 1 day old. This observation illustrates that plaque rupture and coronary occlusion are significantly separated in time. In the present study, we correlate the presence of fresh versus older thrombus with long-term mortality.Methods and Results-Thrombus aspiration was performed in 1315 patients treated with primary percutaneous coronary intervention with 3 devices (Rescue, Export, and Proxis). Aspirated material was fixed in formalin and processed for histopathology. If possible, thrombus age was classified as either fresh only (1 day). We identified fresh thrombus in 552 patients and older thrombus in 372 patients. The cumulative Kaplan-Meier estimate of all-cause mortality at 4 years was significantly higher in patients with older thrombus (16.0%) compared with patients with fresh thrombus (7.4%), with a hazard ratio of 1.82 (95% confidence interval, 1.17 to 2.85; P=0.008). Multivariate analysis identified the presence of older thrombus, in addition to other established predictors, as an independent predictor (hazard ratio, 1.83; 95% confidence interval, 1.14 to 2.93; P=0.01) of long-term mortality.Conclusion-Our study demonstrates that the presence of older thrombus, in addition to other established predictors, is an independent predictor of long-term mortality in patients with ST-elevation myocardial infarction treated with thrombus aspiration during primary percutaneous coronary intervention. (Circulation. 2008; 118: 1810-1816.)