【論文摘要】Impact of Distal Protection or Glycoprotein IIb/IIIa Inhibitor Combined with Aspiration Thrombectomy in Primary PCI On Short-term Angiographic and Echocardiographic Results and Long-term Clinical Outcomes

Pei-Hsun Sung ； Hon-Kan Yip ； Chiung-Jen Wu ； Cheng-Hsu Yang ； Chieh-Jen Chen ； Shu-Kai Hsueh

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 85-85

https://doi.org/10.6907/SCJ.201909/SP_1(2).0071

摘要

Background/Synopsis: Growing evidences have shown that routine thrombosuction during primary percutaneous coronary intervention (PPCI) for culprit vessel lacks clinical benefits in acute ST-segment elevation myocardial infection (STEMI). However, whether combination of distal protection (DP) or glycoprotein IIb/IIIa inhibitor (GPI) with aspiration thrombectomy (Tb) in STEMI could further improve angiographic results and left ventricular (LV) function remains unanswered. Objectives/Purpose: We intended to study the impact of combination thrombectomy strategies on clinical outcomes in the STEMI patients presenting with high thrombus-burden lesions. Methods/Results: Methods: This was a prospective single-center trial conducted from February 2014 to August 2017. A total of 214 patients with acute STEMI undergoing PPCI were consecutively enrolled. The DP/GPI/Tb group (n=72) was defined as the STEMI patients who received combination strategy for high thrombus burden (defined as TIMI thrombus grade 4 or 5) during PPCI. The Tb-only group (n=142) was defined as those undergoing routine aspiration thrombectomy only. Guideline-directed medical therapy including antithrombotic and cardioprotective agents was similarly administered to both groups. All study subjects received angiographic, electrocardiographic and echocardiographic assessment during hospitalization. The 9-month echocardiographic study and 1-year clinical outcomes were also evaluated. Additionally, the levels of serum irisin, a recently identified myokine regulating mitochondrial function, were checked at the start of PPCI and 1 month after discharge. Results: At the beginning of PPCI, the DP/GPI/Tb group had significantly higher pre-PCI lesion stenosis (97.4% vs 92.9%, p=0.045) but lower TIMI flow (0.43 vs 0.75, p=0.023) and irisin level (246.7 vs 445.3 pg/mL, p=0.040) compared with Tb-only group. Both groups achieved similar final TIMI-3 epicardial coronary flow after PCI. Additionally, the TIMI myocardial perfusion grade (2.64 vs 2.42, p=0.027) and 90-min ST resolution rate (68.5% vs 57.5%, p=0.012) were significantly higher in the DP/GPI/Tb than the Tb-only group. Concordantly, the patients receiving combination strategy had better 3D LV ejection fracture (55.7% vs 52.7%, p=0.027) and 2D global longitudinal strain (-14.5% vs -13.1%, p=0.035) on the in-hospital echocardiography. However, follow-up 1-month irisin level, 9-month echocardiographic results, and 1-year clinical outcomes including cardiovascular death, MI, stroke and rehospitalization for heart failure did not differ between groups. Conclusion: In terms of high thrombus burden in the culprit lesion of STEMI, combination strategy during PPCI provides better immediate improvement of myocardial perfusion and short-term LV systolic function, whereas lacks long-term benefits on reducing clinical events.