Effect Of Thrombus Aspiration In Patients With ST Segment Elevation Myocardial Infarction With Different Thrombus Burdens

Objectives ST segment elevation myocardial infarction(STEMI)undergoing emergency Percutaneous coronary intervention(PCI).Methods from September 2016 to June 2020,416 Patients with complete occlusion of cul Prit vessels who received direct percutaneous coronary intervention(PPCI)in the heart center of Hebei Provincial People’s hospital were selected as the research objects.According to whether thrombus aspiration was performed before PPCI,they were divided into control group and aspiration group.The control group was treated with PCI alone,and the aspiration group was treated with thrombus aspiration combined with PCI.According to the different thrombus load,the patients were divided into thrombus grade 4 group and grade 5 group.The general information,the number of diseased vessels and TIMI grade of preoperative blood flow were recorded.The incidence of major adverse cardiac events(MACE)including all-cause death,cardiovascular death,recurrent myocardial infarction,rehospitalization of heart failure and revascularization in patients with thrombus grade 5 were followed up.The main safety end point was stroke after discharge The median follow-up time was(30.0 ±10.34)months.Results There was no significant difference in general information and intervention related data between the two kinds of thrombus load patients(P>0.05);the hospital mortality rate of patients in grade 5 aspiration group was lower than that of control group,the difference was statistically significant(P<0.05);the incidence of hospital heart failure in the suction group was lower than that in the suction group,the difference was statistically significant(P<0.05);the TIMI blood flow rate of the suction group was lower than that of the control group,the difference was not statistically significant(P<0.05).The difference was statistically significant(P>0.05).The in-hospital mortality and prevalence of in-hospital heart failure in the 4-stage aspiration group were lower than those in the aspiration group,and the difference was not statistically significant(P>0.05);the rate of TIMI blood flow less than grade 3 was similar to that of the control group,and the difference was not statistically significant(P>0.05).Multivariate Cox regression analysis showed that thrombus aspiration(HR=0.436,95% CI 0.246-0.770,P=0.004)was a protective factor for mace in patients with PPCI.Male(HR=3.389,95% CI 1.334-8.614,P=0.010),smoking history(HR=3.917,95%CI 1.629-9.418,P=0.002),hypertension(HR = 1.835,95% CI: 1.013-3.325,P=0.045)were risk factors for mace after PPCI.Conclusions 1 For STEMI patients with thrombus grade 5,intraoperative thrombus aspiration may improve the short-term and long-term prognosis of patients without increasing the risk of stroke.2 For STEMI patients with thrombus grade 4,the incidence of in-hospital clinical events in patients with thrombus aspiration was similar to that in patients with PCI alone.3 Male and smoking history were risk factors for mace after PPCI in patients with thrombus grade 5.4 Thrombus aspiration for STEMI patients with high thrombus load may not increase the risk of stroke.Figure 1;Table 8;Reference 160...