Objective:To evaluate the factor of effective thrombus aspiration on outcomes during primary PCI in acute myocardial infarction patients.Methods:To select the AMI patients who undergoing primary PCI and receiving thro...Objective:To evaluate the factor of effective thrombus aspiration on outcomes during primary PCI in acute myocardial infarction patients.Methods:To select the AMI patients who undergoing primary PCI and receiving thrombus aspiration catheter during January 2008 to December 2008(n=226).Technical success of thrombectomy(device success)was defined as the ability of the device to cross the target lesion and to increase flow by>1.178 patients were enrolled in effective thrombus aspiration group,and 48 patients were enrolled in control group.To compare the immediate and in-hospital results between the two groups.Results:Age,sex,hypertension,LVEF,disease vessels,ischemic time,operate time,acute and subacute stent thrombosis,faster ST segment resolution were no significant differences between two groups(P> 0.05).Compared with the control group,smoke(44.9% vs 68.8%,P= 0.003),diabetes(18.5% vs 31.3%,P= 0.047),TIMI flow grade 0 pre-procedure(70.8% vs 85.4%,P= 0.043),no-reflow /slow flow post-PCI(2.2% vs 10.4%,P= 0.022),intracoronary Tirofiban(23.6% vs 64.2%,P=0.000)were decreased in the effective thrombus aspiration group.And TIMI flow grade 3 post-PCI(93.3% vs 77.1%,P=0.002),the rate of direct stent(44.9% vs 20.8%,P=0.003)were improved in the effective thrombus aspiration group.Logistic analysis showed that smoke(OR=1.551,95%CI:1.018-2.154,P= 0.012),diabetes(OR=1.132,95%CI:0.276-3.562,P= 0.044),TIMI flow grade 0 pre-procedure(OR=0.544,95%CI:0.368-1.911,P= 0.035)were independent factors of effective thrombus aspiration.Conclusion:Effective thrombus aspiration may improved TIMI flow grade 3 post-PCI and induce impaired myocardial perfusion,effect factors of effective thrombus aspiration should be paid more attention and reduced to achieved better clinical prognosis.展开更多
Objectives: The goal of this work was to determine whether rheolytic thrombectomy(RT) as an adjunct to primary percutaneous coronary intervention(PCI) reduces infarction size and improves myocardial perfusion during t...Objectives: The goal of this work was to determine whether rheolytic thrombectomy(RT) as an adjunct to primary percutaneous coronary intervention(PCI) reduces infarction size and improves myocardial perfusion during treatment of ST-segment elevation myocardial infarction(STEMI). Background: Primary PCI for STEMI achieves brisk epicardial flow in most patients, but myocardial perfusion often remains suboptimal. Distal embolization of thrombus during treatment may be a contributing factor. Methods: This prospective, multicenter trial enrolled 480 patients presenting within 12 h of symptom onset and randomized to treatment with RT as an adjunct to PCI(n=240) or to PCI alone(n=240). Visible thrombus was not required. The primary end point was infarct size measured by sestamibi imaging at 14 to 28 days. Secondary end points included final Thrombolysis In Myocardial Infarction(TIMI) flow grade, tissue myocardial perfusion(TMP) blush, ST-segment resolution, and major adverse cardiac events(MACE), defined as the occurrence of death, new Q-wave myocardial infarction, emergent coronary artery bypass grafting, target lesion revascularization, stroke, or stent thrombosis at 30 days. Results: Final infarct size was higher in the adjunct RT group compared with PCI alone (9.8±10.9%vs. 12.5±12.13%; p=0.03). Final TIMI flow grade 3 was lower in the adjunct RT group(91.8%vs. 97.0%in the PCI alone group; p< 0.02), although fewer patients had baseline TIMI flow grade 3 in the adjunct RT group(44%vs. 63%in the PCI alone group; p< 0.05). There were no significant differences in TMP blush scores or ST-segment resolution. Thirty-day MACE was higher in the adjunct RT group(6.7%vs. 1.7%in the PCI alone group; p= 0.01), a difference primarily driven by very low mortality rate in patients treated with PCI alone(0.8%vs. 4.6%in patients treated with adjunct RT; p=0.02). Conclusions: Despite effective thrombus removal, RT with primary PCI did not reduce infarct size or improve TIMI flow grade, TMP blush, ST-segment resolution, or 30-day MACE.展开更多
文摘Objective:To evaluate the factor of effective thrombus aspiration on outcomes during primary PCI in acute myocardial infarction patients.Methods:To select the AMI patients who undergoing primary PCI and receiving thrombus aspiration catheter during January 2008 to December 2008(n=226).Technical success of thrombectomy(device success)was defined as the ability of the device to cross the target lesion and to increase flow by>1.178 patients were enrolled in effective thrombus aspiration group,and 48 patients were enrolled in control group.To compare the immediate and in-hospital results between the two groups.Results:Age,sex,hypertension,LVEF,disease vessels,ischemic time,operate time,acute and subacute stent thrombosis,faster ST segment resolution were no significant differences between two groups(P> 0.05).Compared with the control group,smoke(44.9% vs 68.8%,P= 0.003),diabetes(18.5% vs 31.3%,P= 0.047),TIMI flow grade 0 pre-procedure(70.8% vs 85.4%,P= 0.043),no-reflow /slow flow post-PCI(2.2% vs 10.4%,P= 0.022),intracoronary Tirofiban(23.6% vs 64.2%,P=0.000)were decreased in the effective thrombus aspiration group.And TIMI flow grade 3 post-PCI(93.3% vs 77.1%,P=0.002),the rate of direct stent(44.9% vs 20.8%,P=0.003)were improved in the effective thrombus aspiration group.Logistic analysis showed that smoke(OR=1.551,95%CI:1.018-2.154,P= 0.012),diabetes(OR=1.132,95%CI:0.276-3.562,P= 0.044),TIMI flow grade 0 pre-procedure(OR=0.544,95%CI:0.368-1.911,P= 0.035)were independent factors of effective thrombus aspiration.Conclusion:Effective thrombus aspiration may improved TIMI flow grade 3 post-PCI and induce impaired myocardial perfusion,effect factors of effective thrombus aspiration should be paid more attention and reduced to achieved better clinical prognosis.
文摘Objectives: The goal of this work was to determine whether rheolytic thrombectomy(RT) as an adjunct to primary percutaneous coronary intervention(PCI) reduces infarction size and improves myocardial perfusion during treatment of ST-segment elevation myocardial infarction(STEMI). Background: Primary PCI for STEMI achieves brisk epicardial flow in most patients, but myocardial perfusion often remains suboptimal. Distal embolization of thrombus during treatment may be a contributing factor. Methods: This prospective, multicenter trial enrolled 480 patients presenting within 12 h of symptom onset and randomized to treatment with RT as an adjunct to PCI(n=240) or to PCI alone(n=240). Visible thrombus was not required. The primary end point was infarct size measured by sestamibi imaging at 14 to 28 days. Secondary end points included final Thrombolysis In Myocardial Infarction(TIMI) flow grade, tissue myocardial perfusion(TMP) blush, ST-segment resolution, and major adverse cardiac events(MACE), defined as the occurrence of death, new Q-wave myocardial infarction, emergent coronary artery bypass grafting, target lesion revascularization, stroke, or stent thrombosis at 30 days. Results: Final infarct size was higher in the adjunct RT group compared with PCI alone (9.8±10.9%vs. 12.5±12.13%; p=0.03). Final TIMI flow grade 3 was lower in the adjunct RT group(91.8%vs. 97.0%in the PCI alone group; p< 0.02), although fewer patients had baseline TIMI flow grade 3 in the adjunct RT group(44%vs. 63%in the PCI alone group; p< 0.05). There were no significant differences in TMP blush scores or ST-segment resolution. Thirty-day MACE was higher in the adjunct RT group(6.7%vs. 1.7%in the PCI alone group; p= 0.01), a difference primarily driven by very low mortality rate in patients treated with PCI alone(0.8%vs. 4.6%in patients treated with adjunct RT; p=0.02). Conclusions: Despite effective thrombus removal, RT with primary PCI did not reduce infarct size or improve TIMI flow grade, TMP blush, ST-segment resolution, or 30-day MACE.
