Effect of Selective Thrombus Aspiration on Serum Lipoprotein-Associated Phospholipase A2 in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention with High Thrombus Burden

Bao-Feng Chen ； Yun Deng ； Xin Xu ； Shao-Chun Ma ； Liang-Qiu Tang ； Jin-Feng Chen ； Wei-Qian Sun ； Su-Fang Liu ； Jia-Rong Liang

《Acta Cardiologica Sinica》 34卷3期 (2018/05) Pp. 233-241

https://doi.org/10.6515/ACS.201805_34(3).20170227A

摘要

Background: Lipoprotein-associated phospholipase A2 (Lp-PLA_2) is a potential therapeutic target in acute coronary syndromes. Although recent evidence does not support the routine use of manual thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), the use of TA is associated with a significant improvement in myocardial reperfusion, especially in patients with high thrombus burden (HTB). We hypothesized that TA would reduce the serum Lp-PLA_2 levels in STEMI patients undergoing PPCI with HTB. Methods and results: Our study cohort included 320 consecutive STEMI patients undergoing PPCI with HTB who were randomly assigned to receive either TA before PPCI (TA group, n = 160) or PPCI alone (standard PPCI group, n = 160). The baseline characteristics of study participants were well-matched. After 30±2 days, serum Lp-PLA_2 levels decreased by 53.9% in the TA group (152.9±58.1 ng/mL) and decreased by 31.2% in the standard PPCI group (84.2±86.6 ng/mL, p ＜ 0.001). The TA group had a significantly lower prevalence of balloon predilatation, number of stents used, total stent length and corrected thrombolysis in myocardial infarction frame count, and a higher percentage of myocardial blush grade ≥ 2 compared with the standard PPCI group (all p ＜ 0.001). No significant difference between the groups was observed in 30±2 days for major adverse cardiovascular and cerebrovascular events (p = 0.702). Conclusions: After 30±2 days of treatment, TA may significantly reduce serum levels of Lp-PLA_2 in STEMI patients undergoing PPCI with HTB.

關鍵字

Lipoprotein-associated phospholipase A2 ； Primary percutaneous coronary intervention ； ST-elevation myocardial infarction ； Thrombus aspiration