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心肌梗死患者行血栓抽吸术后1年的结局
Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction


Bo Lagerqvist ... 心脑血管疾病 • 2014.09.18

摘要


背景

目前尚未证实对ST段抬高型心肌梗死(STEMI)患者行皮冠状动脉介入治疗(PCI)前常规行冠状动脉内血栓抽吸术能降低近期死亡率。我们对此类患者在行血栓抽吸术后1年的结局进行了评估。

 

方法

我们在一项以注册为基础的随机临床试验中,将7,244例STEMI患者随机分为两组,一组在手动血栓抽吸术后再行PCI,另一组单纯进行PCI。30天全因死亡率的主要终点过去已有报告。本试验1年全因死亡为预设次要终点。

 

结果

随访过程中无患者失访。血栓抽吸组患者的全因死亡率为5.3%(191/3,621),单纯PCI组为5.6%(202/3,623)(风险比0.94;95%可信区间[CI],0.78~1.15;P=0.57);两组的1年心肌梗死再住院发生率分别为2.7%和2.7%(风险比0.97;95% CI,0.73~1.28;P=0.81);支架内血栓形成发生率分别为0.7%和0.9%(风险比0.84;95% CI,0.50~1.40;P=0.51);任何原因死亡、心肌梗死再住院和支架内血栓形成的复合发生率分别为8.0%和8.5%(风险比0.94;95% CI,0.80~1.11;P=0.48);所有主要亚组(包括PCI前血栓负担和冠状动脉血流评分等级)所得结果一致。

 

结论

对STEMI患者PCI术前常规行血栓抽吸术,与单纯PCI相比,术后1年的任何原因死亡率或任何原因死亡、心肌梗死再住院和支架内血栓形成的复合终点均没有降低(由瑞典研究委员会[Swedish Research Council]和其他机构资助;TASTE ClinicalTrials.gov注册号为NCT01093404)。





作者信息

Bo Lagerqvist, M.D., Ph.D., Ole Fröbert, M.D., Ph.D., Göran K. Olivecrona, M.D., Ph.D., Thórarinn Gudnason, M.D., Ph.D., Michael Maeng, M.D., Ph.D., Patrik Alström, M.D., Jonas Andersson, M.D., Ph.D., Fredrik Calais, M.D., Jörg Carlsson, M.D., Ph.D., Olov Collste, M.D., Matthias Götberg, M.D., Ph.D., Peter Hårdhammar, M.D., Dan Ioanes, M.D., Anders Kallryd, M.D., Rickard Linder, M.D., Ph.D., Anders Lundin, M.D., Jacob Odenstedt, M.D., Elmir Omerovic, M.D., Ph.D., Verner Puskar, M.D., Tim Tödt, M.D., Ph.D., Eva Zelleroth, M.D., Ollie Östlund, Ph.D., and Stefan K. James, M.D., Ph.D.
From the Department of Medical Sciences, Cardiology Section, and Uppsala Clinical Research Center, Uppsala University, Uppsala (B.L., O.O., S.K.J.), Department of Cardiology, Örebro University Hospital, Örebro (O.F., F.C.), Department of Coronary Heart Disease, Skane University Hospital, Clinical Sciences Section, Lund University, Lund (G.K.O., M.G., A.L.), Department of Cardiology, Karolinska Institutet, Södersjukhuset (P.A., O.C.), and Department of Cardiology, Karolinska Institutet, Danderyd (R.L.), Stockholm, Department of Cardiology, Umeå University Hospital, Umeå (J.A.), Section of Cardiology, Kalmar County Hospital and Linnaeus University, Kalmar (J.C.), Department of Cardiology, Halmstad Hospital, Halmstad (P.H.), Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (D.I., J.O., E.O.), Department of Cardiology, Skaraborgs Hospital, Skövde (A.K.), Department of Radiology, Ryhov Hospital, Jönköping (V.P.), Department of Cardiology, Linköping University Hospital, Linköping (T.T.), and Department of Radiology, Mälarsjukhuset, Eskilstuna (E.Z.) — all in Sweden; Department of Cardiology and Cardiovascular Research Center, Landspitali University Hospital, Reykjavik, Iceland (T.G.); and the Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (M.M.). Address reprint requests to Dr. James at the Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden, or at stefan.james@ucr.uu.se.

 

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