血栓吸栓所有STEMI都需要嗎TOTAL研究的回答.pptVIP

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血栓吸栓所有STEMI都需要嗎TOTAL研究的回答.ppt

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血栓吸栓所有STEMI都需要嗎TOTAL研究的回答

血栓吸栓：所有STEMI都需要吗？ -TOTAL研究的回答徐亚伟同济大学附属第十人民医院 Thrombectomy use only 4% of PPCI in USA Data from ACC NDR registry of 217,355 primary PCI procedures International Survey: Routine Use of Aspiration Thrombectomy during PPCI Only 36% use aspiration thrombectomy routinely with no significant variation by region Russo J, et al. Circulation. 2010 TIMI Myocardial Perfusion (TMP) Grades 6.2% 4.4% 2.0% n = 203 n = 46 n = 434 TMP Grade 3 p = 0.05 Mortality (%) n = 79 5.1% Gibson et al, Circulation 2000 TMP Grade 2 TMP Grade 1 TMP Grade 0 ? Gibson CM 2004 AIMI Trial: Mechanical Thrombectomy increased infarct size and mortality (n=480） P=0.03 Ali, A, et al. JACC.2006;48:244-.252. 535 were assigned to thrombus aspiration with Export 530 complete follow-up at 1 year 536 were assigned to conventional PCI 530 complete follow-up at 1 year 1st endpoint: Myocardial blush grade (core lab) 2nd endpoint: ST-segment elevation resolution 30 day death and death/reinfarction 1 year death and death/reinfarction Svilaas et al . N. Engl. J. Med. 358 (2008) 557-567 STEMI 12 hrs of sx onset N=1071 Randomization before angiography TAPAS Study Design TAPAS trial: Benefit for Surrogate Outcome Single center trial of Thrombectomy (Export?) vs. PCI alone during PPCI (N=1071) Benefit for primary outcome of myocardial blush grade 0 or 1 (poor microvascular flow) P0.001 Svilaas T, et al. N Engl J Med. 2008;358:557-67. Trend at 30 days became significant at 1 year Experts cautioned that a large confirmatory trial is needed (small trials with unexpected large effect sizes, need to be replicated) TAPAS: Unexpected Reductionin Mortality at 1 year JET STENT (N=501): No difference in Infarct Size, mortality with mechanical thrombectomy Migliorini, A, et al. JACC. 2010;56:1298. P=0.40 P=ns MUSTELA (N=208), high thrombus burden, no difference in Infarct Size and MACE Petronio A, TCT 2011, LBCT P=0.54 MACE at 1 year How do we explain conflicting re