ESC 2013:真实世界研究发现采用血栓抽吸并不减少PCI后患者的1年生存率(FAST-MI2010注册研究)

2013-09-03 MedSci MedSci原创

  背景:ST段抬高心肌梗死(STEMI)时采用血栓抽吸行直接PCI是否会增加患者的死亡率仍是一个存在争议的问题。该研究评估了FAST-MI 2010注册研究中行直接PCI时应用了血栓抽吸的STEMI患者的1年生存率。   方法:FAST-MI 2010研究是法国的一项全国性注册研究,共计在2010年末从213家中心入选41 169例急性心肌梗死(AMI)患者,其中2438例伴有STEM

  背景:ST段抬高心肌梗死(STEMI)时采用血栓抽吸行直接PCI是否会增加患者的死亡率仍是一个存在争议的问题。该研究评估了FAST-MI 2010注册研究中行直接PCI时应用了血栓抽吸的STEMI患者的1年生存率。

  方法:FAST-MI 2010研究是法国的一项全国性注册研究,共计在2010年末从213家中心入选41 169例急性心肌梗死(AMI)患者,其中2438例伴有STEMI或左束支传导阻滞。上述患者中有1497例进行了直接PCI,其中663例(44%) 应用了血栓抽吸。

  结果:与未应用者相比,应用了血栓抽吸的患者更年轻(61岁 vs. 63岁,P=0.01),GRACE评分相当(140 vs. 143,P=0.10),发病持续时间更短( 245 分钟vs. 285分钟,P=0.001),更多到学院型医院就诊(46% vs. 35%,P<0.001);但AMI部位、MI/ PCI/CABG病史无显著差异。此外,应用及未应用血栓抽吸者30天内死亡率(2.1% vs. 2.3%,P=0.71)及1年生存率(95.5% vs. 94.8%,P=0.59)均无显著差异。Cox多因素分析结果显示,与未应用者相比,应用血栓抽吸者1年内死亡的校正后HR为1.02(95%CI:0.54~1.91,P=0.96)。计算血栓抽吸的倾向评分,并对基线特征相似的两组各550例患者进行对比分析。结果发现,应用与未应用血栓抽吸者30天死亡率(1.1% vs. 1.5%,P=0.59)及1年生存率(96.4% vs. 96.2%,P=0.90)均无差异。

  结论:在真实世界环境中应用血栓抽吸并不能改善患者的一年生存率。

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    2014-06-24 JR19860219
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    2014-02-21 gracezdd
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