[1]刘如晨,综述,徐争鸣,等.血栓抽吸在急性ST段抬高型心肌梗死中的研究进展[J].心血管病学进展,2016,(3):240-243.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.006]
　LIU Ruchen,XU Zhengming,LI Tianchang.Thrombus Aspiration in the Treatment of Acute ST-segment Elevation Myocardial Infarction[J].Advances in Cardiovascular Diseases,2016,(3):240-243.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.006]
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血栓抽吸在急性ST段抬高型心肌梗死中的研究进展()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2016年3期
页码:
240-243
栏目:
综述
出版日期:
2016-06-20

文章信息/Info

Title:
Thrombus Aspiration in the Treatment of Acute ST-segment Elevation Myocardial Infarction
作者:
刘如晨; 综述; 徐争鸣; 李田昌; 审校
中国人民解放军海军总医院心脏中心,北京 100048
Author(s):
LIU Ruchen; XU Zhengming; LI Tianchang
Heart Center, The PLA Army Navy General Hospital,Beijing 100048,China
关键词:
血栓;  血栓抽吸;  心肌再灌注;  心肌梗死;  无复流
Keywords:
Thrombus;  Thrombectomy;  Myocardial reperfusion;  Myocardial infarction;  No-reflow
分类号:
R542.2
DOI:
10.16806/j.cnki.issn.1004-3934.2016.03.006
文献标志码:
A
摘要:
冠状动脉粥样硬化斑块破裂及其所导致的血栓形成是急性ST段抬高型心肌梗死的病理生理学基础,及时有效的再灌注治疗是治疗的关键。经皮冠状动脉介入术是开通闭塞血管、改善患者预后的重要治疗手段,然而仍有1/3的患者在植入支架后心肌未得到有效的灌注,目前较公认的观点是血栓和斑块脱落引起微循环栓塞而导致无复流现象的发生,无复流的发生与患者的不良预后相关,增加心源性死亡、心力衰竭、恶性心律失常、住院期间死亡的发生率。血栓抽吸能够减少无复流的发生,但是对于患者临床预后的影响仍存在争议。现主要对血栓抽吸在急性ST段抬高型心肌梗死中的应用现状及进展进行综述。
Abstract:
ST-segment elevation myocardial infarction is characteried by plaque rupture and occlusion of the infarct artery with thrombus. Reperfusion of myocardial tissue is the main goal of primary percutaneous coronary intervention(PPCI)with stent implantation in the treatment of acute ST-segment elevation myocardial infarction. Although PPCI has contributed to a dramatic reduction in cardiovascular mortality, normal myocardial perfusion is not restored in approximately one-third of these patients. Several mechanisms may contribute to myocardial reperfusion failure, in particular distal embolization of the thrombus and plaque fragments failure. No-reflow is associated with poor prognosis in patients with increased cardiac death, heart failure, malignant arrhythmia death during hospitalization. Aspiration thrombectomy during PPCI has been proposed to prevent embolization in order to improve these outcomes. Even though numerous international studies haven, there are conflicting results on the clinical impact of aspiration thrombectomy during PPCI. In particular, the data on long-term clinical outcomes are still inconsistent. In this review,we have carefully analyzed literature data on thrombectomy during PPCI, taking into account the most recent studies.

参考文献/References:

[1] Falk E. Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis. Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi[J]. Br Heart J,1983,50(2):127-134.
[2] Mauri L, Cox D, Hermiller J, et al. The PROXIMAL trial: proximal protection during saphenous vein graft intervention using the Proxis Embolic Protection System:a randomized, prospective, multicenter clinical trial[J]. J Am Coll Cardiol,2007,50(15):1442-1449.
[3] Nagata Y, Usuda K, Uchiyama A, et al. Characteristics of the pathological images of coronary artery thrombi according to the infarct-related coronary artery in acute myocardial infarction[J]. Circ J, 2004,68(4):308-314.
[4] Yunoki K, Naruko T, Inoue T, et al. Relationship of thrombus characteristics to the incidence of angiographically visible distal embolization in patients with ST-segment elevation myocardial infarction treated with thrombus aspiration[J]. JACC Cardiovasc Interv,2013,6(4):377-385.
[5] Arakawa K, Yasuda S, Hao H, et al. Significant association between neutrophil aggregation in aspirated thrombus and myocardial damage in patients with ST-segment elevation acute myocardial infarction[J]. Circ J, 2009,73(1):139-144.
[6] Sianos G, Papafaklis MI, Daemen J, et al. Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction:the importance of thrombus burden[J]. J Am Coll Cardiol, 2007,50(7):573-583.
[7] Kramer MC, van der Wal AC, Koch KT, et al. Presence of older thrombus is an independent predictor of long-term mortality in patients with ST-elevation myocardial infarction treated with thrombus aspiration during primary percutaneous coronary intervention[J]. Circulation,2008,118(18):1810-1816.
[8] Gibson CM, de Lemos JA, Murphy SA, et al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction:a TIMI 14 substudy[J]. Circulation, 2001,103(21):2550-2554.
[9] Sianos G, Papafaklis MI, Daemen J, et al. Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction:the importance of thrombus burden[J]. J Am Coll Cardiol,2007,50(7):573-583.
[10] Valente S, Lazzeri C, Mattesini A, et al. Thrombus aspiration in elderly STEMI patients:a single center experience[J]. Int J Cardiol,2013,168(3):3097-3099.
[11] Bhindi R, Kajander OA, Jolly SS, et al. Culprit lesion thrombus burden after manual thrombectomy or percutaneous coronary intervention-alone in ST-segment elevation myocardial infarction:the optical coherence tomography sub-study of the TOTAL(ThrOmbecTomy versus PCI ALone)trial[J]. Eur Heart J, 2015,36(29):1892-1900.
[12] Constantinides S, Lo TS, Been M, et al. Early experience with a helical coronary thrombectomy device in patients with acute coronary thrombosis[J]. Heart,2002,87(5):455-460.
[13] Parodi G, Valenti R, Migliorini A, et al. Comparison of manual thrombus aspiration with rheolytic thrombectomy in acute myocardial infarction[J]. Circ Cardiovasc Interv,2013,6(3):224-230.
[14] Burzotta F, Trani C, Romagnoli E, et al. Manual thrombus-aspiration improves myocardial reperfusion: the randomized evaluation of the effect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue angioplasty(REMEDIA)trial[J]. J Am Coll Cardiol,2005,46(2):371-376.
[15] Silva-Orrego P, Colombo P, Bigi R, et al. Thrombus aspiration before primary angioplasty improves myocardial reperfusion in acute myocardial infarction:the DEAR-MI(Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction)study[J]. J Am Coll Cardiol,2006,48(8):1552-1559.
[16] Burzotta F, Trani C, Romagnoli E, et al. Manual thrombus-aspiration improves myocardial reperfusion[J]. J Am Coll Cardiol,2005,46(2):371-376.
[17] Noman A, Egred M, Bagnall A, et al. Impact of thrombus aspiration during primary percutaneous coronary intervention on mortality in ST-segment elevation myocardial infarction[J]. Eur Heart J, 2012,33(24):3054-3061.
[18] Vlaar PJ, Svilaas T, van der Horst IC, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study(TAPAS):a 1-year follow-up study[J]. Lancet,2008,371(9628):1915-1920.
[19] Burzotta F, de Vita M, Gu YL, et al. Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials[J]. Eur Heart J,2009,30(18):2193-2203.
[20] Jones DA, Rathod KS, Gallagher S, et al. Manual thrombus aspiration is not associated with reduced mortality in patients treated with primary percutaneous coronary intervention: an observational study of 10,929 patients with ST-segment elevation myocardial infarction from the London Heart Attack Group[J]. JACC Cardiovasc Interv,2015,8(4):575-584.
[21] Lagerqvist B, Frobert O, Olivecrona GK, et al. Outcomes 1 year after thrombus aspiration for myocardial infarction[J]. N Engl J Med, 2014,371(12):1111-1120.
[22] Watanabe H, Shiomi H, Nakatsuma K, et al. Clinical efficacy of thrombus aspiration on 5-year clinical outcomes in patients with ST-segment elevation acute myocardial infarction undergoing percutaneous coronary intervention[J]. J Am Heart Assoc,2015,4(6):e1962.
[23] Frobert O,Lagerqvist B,Olivecrona GK,et al.Thrombus aspiration during ST-segment elevation myocardial infarction[J]. N Engl J Med,2013,369(17):1587-1597.
[24] Jolly SS,Cairns JA,Yusuf S,et al.Randomized trial of primary PCI with or without routine manual thrombectomy[J]. N Engl J Med,2015,372(15):1389-1398.
[25] Jolly SS,Cairns JA,Yusuf S,et al. Outcomes after thrombus aspiration for ST elevation myocardial infarction:1-year follow-up of the prospective randomised TOTAL trial[J]. Lancet, 2016,387(10014):127-135.
[26] Parodi G, Valenti R, Migliorini A, et al. Comparison of manual thrombus aspiration with rheolytic thrombectomy in acute myocardial infarction[J]. Circ Cardiovasc Interv,2013,6(3):224-230.
[27] Bavry AA, Kumbhani DJ, Bhatt DL. Role of adjunctive thrombectomy and embolic protection devices in acute myocardial infarction:a comprehensive meta-analysis of randomized trials[J]. Eur Heart J, 2008,29(24):2989-3001.
[28] Navarese EP, Tarantini G, Musumeci G, et al. Manual vs mechanical thrombectomy during PCI for STEMI: a comprehensive direct and adjusted indirect meta-analysis of randomized trials[J]. Am J Cardiovasc Dis, 2013,3(3):146-157.
[29] Antoniucci D, Valenti R, Migliorini A, et al. Comparison of rheolytic thrombectomy before direct infarct artery stenting versus direct stenting alone in patients undergoing percutaneous coronary intervention for acute myocardial infarction[J]. Am J Cardiol,2004,93(8):1033-1035.
[30] Ali A, Cox D, Dib N, et al. Rheolytic thrombectomy with percutaneous coronary intervention for infarct size reduction in acute myocardial infarction:30-day results from a multicenter randomized study[J]. J Am Coll Cardiol,2006,48(2):244-252.
[31] Migliorini A,Stabile A,Rodriguez AE,et al. Comparison of AngioJet rheolytic thrombectomy before direct infarct artery stenting with direct stenting alone in patients with acute myocardial infarction.The JETSTENT trial[J]. J Am Coll Cardiol,2010,56(16):1298-1306.
[32] Stone GW,Maehara A,Witzenbichler B,et al. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction:the INFUSE-AMI randomized trial[J]. JAMA, 2012,307(17):1817-1826.
[33] Stone GW,Witzenbichler B,Godlewski J,et al. Intralesional abciximab and thrombus aspiration in patients with large anterior myocardial infarction:one-year results from the INFUSE-AMI trial[J]. Circ Cardiovasc Interv,2013,6(5):527-534.
[34] Niccoli G,Rigattieri S,de Vita MR,et al.Open-label,randomized,placebo-controlled evaluation of intracoronary adenosine or nitroprusside after thrombus aspiration during primary percutaneous coronary intervention for the prevention of microvascular obstruction in acute myocardial infarction:the REOPEN-AMI study(Intracoronary Nitroprusside Versus Adenosine in Acute Myocardial Infarction)[J]. JACC Cardiovasc Interv,2013,6(6):580-589.
[35] Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology(ESC)and the European Association for Cardio-Thoracic Surgery(EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions(EAPCI)[J].Eur Heart J, 2014,35(37):2541-2619.

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备注/Memo

备注/Memo:
基金项目:海军后勤科研项目(CHJ12L020) 作者简介:刘如晨(1989—),在读硕士,主要从事急性冠状动脉综合征研究。Email: 444532541@qq.com 通信作者:李田昌(1963—),主任医师,博士,主要从事冠心病研究。Email: ltc909@aliyun.com
更新日期/Last Update: 2016-05-25