STEMI 和大血栓负担患者的血栓抽吸失败和心肌灌注减少。

IF 11.7 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Cardiovascular interventions Pub Date : 2024-10-14 DOI:10.1016/j.jcin.2024.07.016
Ho Sung Jeon MD , Young In Kim MD , Jung-Hee Lee MD, PhD , Young Jun Park MD , Jung-Woo Son MD , Jun-Won Lee MD, PhD , Young Jin Youn MD, PhD , Min-Soo Ahn MD, PhD , Jang-Young Kim MD, PhD , Byung-Su Yoo MD, PhD , Sung Min Ko MD, PhD , Sung Gyun Ahn MD, PhD
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引用次数: 0

摘要

背景:血栓抽吸术(TA)用于减少大血栓负荷(LTB),但可能导致远端栓塞:本研究旨在探讨ST段抬高型心肌梗死(STEMI)和LTB患者TA失败对心肌灌注缺陷的影响:共纳入812例STEMI和LTB(血栓等级≥3)患者,这些患者在主要经皮冠状动脉介入治疗期间接受了人工TA。TA失败的定义是没有取回血栓、存在插入前血栓残留或远端栓塞。将TA失败组与TA成功组的最终TIMI(心肌梗死溶栓)血流分级和其他心肌灌注参数进行比对:结果:最终TIMI血流3级的比例在TA失败组(n = 279 [34.4%])低于TA成功组(n = 533 [65.6%])(74.6% vs 82.2%; P = 0.011)。与TA成功组相比,TA失败组的心肌淤血等级更低、ST段分辨率更低,微血管阻塞的发生率更高。TA失败与最终TIMI血流分级低独立相关(风险比:1.525;95% CI:1.048-2.218;P = 0.027)。高龄、Killip分级≥III级、血管迂曲、钙化和左前降支冠状动脉以外的罪魁祸首血管与TA失败有关:结论:TA衰竭与STEMI和LTB患者心肌灌注减少有关。高龄、血流动力学不稳定、冠状动脉解剖结构不良(如迂曲或钙化)以及非左前降支冠状动脉状态可能会影响 TA 的效果。(江原 PCI 前瞻性注册 [GWPCI];NCT02038127)。
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Failed Thrombus Aspiration and Reduced Myocardial Perfusion in Patients With STEMI and Large Thrombus Burden

Background

Thrombus aspiration (TA) is used to decrease large thrombus burden (LTB), but it can cause distal embolization.

Objectives

The aim of this study was to investigate the impact of TA failure on defective myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) and LTB.

Methods

In total, 812 consecutive patients with STEMI and LTB (thrombus grade ≥3) were enrolled, who underwent manual TA during the primary percutaneous coronary intervention. TA failure was defined as the absence of thrombus retrieval, presence of prestenting thrombus residue, or distal embolization. The final TIMI flow grades and other myocardial perfusion parameters of the failed TA group were matched with those of the successful TA group.

Results

The proportion of final TIMI flow grade 3 was lower (74.6% vs 82.2%; P = 0.011) in the failed TA group (n = 279 [34.4%]) than in the successful TA group (n = 533 [65.6%]). The failed TA group also had lower myocardial blush grade, lower ST-segment resolution, and a higher incidence of microvascular obstruction than the successful TA group. TA failure was independently associated with low final TIMI flow grade (risk ratio: 1.525; 95% CI: 1.048-2.218; P = 0.027). Old age, Killip class ≥III, vessel tortuosity, calcification, and a culprit vessel other than the left anterior descending coronary artery were associated with TA failure.

Conclusions

TA failure is associated with reduced myocardial perfusion in patients with STEMI and LTB. Advanced age, hemodynamic instability, hostile coronary anatomy such as tortuosity or calcification, and non–left anterior descending coronary artery status might attenuate TA performance. (Gangwon PCI Prospective Registry [GWPCI]; NCT02038127)
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来源期刊
JACC. Cardiovascular interventions
JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
11.60
自引率
8.80%
发文量
756
审稿时长
4-8 weeks
期刊介绍: JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.
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