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Thrombusaspiration bei Patienten mit akutem Myokardinfarkt

Wissenschaftliche Evidenz und Empfehlungen in den Leitlinien

Thrombus aspiration in patients with acute myocardial infarction

Scientific evidence and guideline recommendations

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Zusammenfassung

Durch Entwicklungen im Bereich der perkutanen Koronarintervention und der Thrombozytenaggregationshemmung sowie durch schnellere „Door-to-balloon“-Zeiten konnte die Therapie des akuten Myokardinfarkts in den letzten Jahren deutlich verbessert werden. Die fehlende myokardiale Perfusion trotz Rekanalisation des Infarktgefäßes stellt jedoch weiterhin ein prognostisch relevantes Problem dar. Die Aspiration von thrombotischem Material im Bereich der Zielläsion zeigte in ersten Studien eine Verbesserung des koronaren Flusses sowie der myokardialen Perfusion und wurde daher in den internationalen Leitlinien empfohlen. Zuletzt konnten jedoch große multizentrische Studien mit klinischen Endpunkten keine Vorteile durch eine routinemäßige Thrombusaspiration bei Patienten mit akutem Myokardinfarkt aufzeigen. Zudem wurde die Sicherheit der Thrombusaspiration aufgrund eines vermehrten Auftretens von Schlaganfällen in Frage gestellt. Dies führte zu einer Herabstufung der Empfehlung in den Leitlinien. Der vorliegende Review fasst die wichtigsten Ergebnisse aus klinischen Studien sowie die derzeitigen Empfehlungen zur Thrombusaspiration bei Patienten mit akutem Myokardinfarkt zusammen.

Abstract

Recent advances in percutaneous coronary intervention and antiplatelet therapy as well as faster door-to-balloon times have markedly improved the therapy of patients with acute myocardial infarction. However, impaired myocardial perfusion despite revascularization of the infarcted vessel remains an ongoing problem with high prognostic relevance. In initial clinical trials thrombus aspiration in addition to conventional percutaneous coronary intervention demonstrated benefits regarding coronary flow and myocardial perfusion and was therefore recommended in practice guidelines. These improvements in surrogate endpoints did not translate into a favorable clinical outcome in recent large-scale multicenter randomized trials investigating the routine use of thrombus aspiration in patients with acute myocardial infarction. Furthermore, an increased risk of stroke after thrombus aspiration raises safety concerns. Therefore, thrombus aspiration has been downgraded in the recent guideline updates. The current article reviews the evidence from clinical trials and the recommendations in practice guidelines regarding thrombus aspiration in acute myocardial infarction.

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Abb. 1

Abbreviations

GP:

Glykoprotein

IQR:

Interquartilsabstand

MBG:

Myocardial Blush Grade

NSTEMI:

Nicht-ST-Strecken-Hebungs-Infarkt

PCI:

Perkutane Koronarintervention

STEMI:

ST-Strecken-Hebungs-Infarkt

TA:

Thrombusaspiration

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Authors and Affiliations

  1. Universitäres Herzzentrum Lübeck, Medizinische Klinik II (Kardiologie/Angiologie/Intensivmedizin), Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    T. Stiermaier, S. de Waha, G. Fürnau, I. Eitel, H. Thiele & S. Desch

  2. Deutsches Zentrum für Herz-Kreislauf-Forschung, Standort Hamburg/Kiel/Lübeck, Lübeck, Deutschland

    T. Stiermaier, S. de Waha, G. Fürnau, I. Eitel, H. Thiele & S. Desch

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  1. T. Stiermaier
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  2. S. de Waha
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Correspondence to T. Stiermaier.

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T. Stiermaier, S. de Waha, G. Fürnau, I. Eitel, H. Thiele und S. Desch geben an, dass kein Interessenkonflikt besteht.

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Stiermaier, T., de Waha, S., Fürnau, G. et al. Thrombusaspiration bei Patienten mit akutem Myokardinfarkt. Herz 41, 591–598 (2016). https://doi.org/10.1007/s00059-016-4412-x

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