Outcomes From Selective Use Of Thrombectomy In STEMI Patients Undergoing PPCI

Objective: Although various clinical trials,meta-analyses and registration studys about thrombus aspiration have been undertaken,the impact of coronary thrombectomy in STEMI has not been definitively established and there has not been clinical trials about selective use of thrombus aspiration.The study compared the conventional PCI and thrombus aspiration on angiographic outcomes and clinical outcomes to evaluate the efficacy of thrombus aspiration in STEMI patients.Methods: A total of 536 patients with STEMI undergoing PPCI from Jan 2013 to Jan 2016 were retrospectively analyzed,which were divided into two groups according to whether undergoing thrombus aspiration treatment during the course of PPCI: thrombus aspiration group(n = 130,24.3%)and conventional PCI group(n = 406,75.7%).We compared the clinical data such as age,sex,hypertension,diabetes,smoking history,cardiac functional grading,ischemia time,ST-segment elevation resolution,postoperative cardiac troponin I(c Tn I),creatine kinase MB(CK-MB)peak,platelet count,the mean platelet volume(MPV),the left ventricular ejection fraction and the left ventricular end diastolic diameter,MACE during admission,and coronary angiography results such as infarct related arteries(IRA),the number of diseased coronary,TIMI,the number,length,diameter of the stand,postoperative TIMI flow grade,corrected TIMI frame count(c TFC),myocardial color grading(MBG),clinical prognosis to evaluate the impact of thrombus aspiration on patients with STEMI.Result: 1.A total of 536 patients with STEMI were enrolled in this study.130(24.3%)underwent thrombectomy with PCI.2.Patients in the thrombus aspiration group compared with the patients in the conventional PCI group were younger,ischemia time was less,the proportion of heart function Killip grade ≥2 was higher(P < 0.05);the differences in sexs,diabetes,hypertension and smoking were not significant(P > 0.05).3.The IRA in the thrombus aspiration group were more likely to be anterior descending artery and right coronary artery;thrombus aspiration group tended to besingle branch lesion,while the conventional PCI group tended to be three lesions;thrombus aspiration group were more likely to present with pre-procedural TIMI flow grade 0 and higher thrombus integral(P<0.05).4.The TIMI flow grade,c TFC and MBG in the thrombus aspiration group were significantly improved in thrombus aspiration group than that in the conventional PCI group(P < 0.05).5.The diameter of stents in the thrombus aspiration group was significantly larger than that of conventional PCI group and the number of balloon dilatation was significantly smaller(P < 0.05).The total length of the stents and the number of the stents did not show significant differences between the two groups(P > 0.05).6.The CK-MB,c Tn I peak,fasting blood glucose and MPV in the thrombus aspiration group were significantly lower than that of the conventional PCI group(P < 0.05);the PLT and N/L ratio did not show significant difference between the two groups(P > 0.05).7.The STR in the thrombus aspiration group was significantly higher than that in the conventional PCI group(P < 0.05).8.There was no significant difference in LVEF and LVDD between the two groups(P > 0.05).9.Multivariate Logistic regression analysis showed that heart function classification,thrombosis,age were independent predictors for thrombus aspiration(P<0.05),while the thrombus aspiration,age,cardiac function,infarct related artery were independent predictors of MACE events(P<0.05).10.There was no significant difference in MACE between two groups in hospital,while MACE in the thrombus aspiration group was significantly lower than the conventional PCI group one year after PCI(P = 0.01).11.The subgroup analysis of heart function classification showed that in patients with the Killip 1,there was no significant difference in MACE between two groups(P > 0.05),while in the patients with Killip≥2,MACE in the thrombus aspiration group was significantly lower than that of conventional PCI group(P < 0.05).Conclusion: 1.Patients who received thrombectomy tended to be slightly younger and more likelyto have shorter ischemia time and poorer heart function.Heart function classification,thrombosis,age were independent predictors for thrombus aspiration 2.Selective use of thrombus aspiration can reduce the incidence of no reflow,improve TIMI flow and the myocardial perfusion and reduce myocardial infarct size,but has no obvious effect on the MACE in hospital.3.Selective use of thrombus aspiration can reduce the incidence of MACE and improve the prognosis of patients.Thrombus aspiration was the independent predictor of MACE.4.Selective use of thrombus aspiration in the STEMI patients with cardiac insufficiency can have more benefits in MACE.