Journal of Hebei Medical University ›› 2021, Vol. 42 ›› Issue (7): 770-778.doi: 10.3969/j.issn.1007-3205.2021.07.006

Previous Articles     Next Articles

Effect of thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction on myocardial reperfusion and clinical prognosis

  

  1. Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, China
  • Online:2021-07-25 Published:2021-08-02

Abstract: Objective To investigate the effect of thrombus aspiration during primary percutaneous coronary intervention(PPCI) in patients with ST-segment elevation myocardial infarction(STEMI) on myocardial reperfusion and clinical prognosis. 
Methods We retrospectively analyzed the clinical data of STEMI patients who underwent PPCI in Hebei General Hospital. Patients were divided into non-thrombus aspiration group(n=230) and thrombus aspiration group(n=216). Clinical data and incidence of postoperative slow blood flow/no-reflow were collected, and major adverse cardiovascular events(MACE), including cardiac death, re-myocardial infraction, target vessal revascularization, and stroke were recorded during 12-month follow-up. 
Results Compared with non-thrombus aspiration group, thrombus aspiration group showed higher use rate of thrombolysis in myocardial infarction(TIMI) thrombus load≥grade 4, preoperative TIMI blood flow <grade 3, intraoperative tirofiban and prourokinase, more intraoperative contrast agent, and lower rate of multivessel lesions(P<05). Binary Logistic regression analysis showed that TIMI thrombus load ≥grade 4 and TIMI blood flow <grade 3 were the influencing factors of thrombus aspiration during PPCI(P<0.05). Age(OR= 1.03,95%CI: 1.004-1.056, P=0.023) and contrast agent dosage(OR=1.004,95%CI: 1-1.008, P=0.047) were independent risk factors for no-reflow. The rate of thrombus aspiration in patients with slow flow/no-reflow was lower than that in patients with normal blood flow. Multivariate analysis showed that thrombus aspiration was not associated with slow flow/no-reflow in the whole population. Killip ≥ 2 and left main coronary artery disease were independent risk factors for MACE, while statins were protective factors for MACE; Killip ≥ 2 was an independent risk factor for cardiac death, while statins and ejection fraction were protective factors for cardiac death. Thrombus aspiration was a protective factor for no-reflow in patients with high thrombus load; Age and dosage of contrast agent were the risk factors of no-reflow in the population with high thrombus load. There was no-significant difference in MACE, cardiac death, recurrent myocardial infarction, target vessel reconstruction and ischemic stroke between the two groups at 12 months after operation(P>0.05). There was no-significant difference in MACE and cardiac death by Kaplan Meier survival analysis between two groups. Cox regression analysis showed that thrombus aspiration was not the influencing factor of MACE and cardiac death in the population with high thrombus load. 
Conclusion Thrombus aspiration could reduce the incidence of slow flow/no-reflow in patients with high thrombus load, but could not improve clinical prognosis at 12 months after operation.


Key words: myocardial infraction, percutaneous coronary intervention, thrombectomy