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Clinical and angiographic predictors and prognostic value of failed thrombus aspiration in primary percutaneous

Maarten A Vink1, Miranda C Kramer, Xiaofei Li

  • 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

JACC. Cardiovascular Interventions
|June 25, 2011
PubMed

Insights

Thrombus aspiration (TA) during ST-segment elevation myocardial infarction is often unsuccessful in patients with tortuous, calcified, or bifurcation lesions. However, failed TA does not impact 1-year mortality rates.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Thrombus aspiration (TA) is a technique used during primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.
  • The clinical benefits and underlying mechanisms of TA remain subjects of ongoing research and debate.
  • Understanding factors influencing TA success is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To identify predictors of thrombus aspiration failure in patients with acute ST-segment elevation myocardial infarction.
  • To determine if TA failure has any prognostic implications on 1-year mortality.

Main Methods:

  • A cohort of 1,399 patients undergoing TA between 2001 and 2007 was analyzed.
  • TA failure was defined as the inability to reach or effectively cross the occluded artery with the aspiration catheter.
  • Clinical and angiographic variables were examined for association with TA failure and lack of aspirate, with 1-year vital status follow-up.

Main Results:

  • Aspiration catheter failure occurred in 10.3% of patients (144/1399).
  • Independent predictors of TA failure included marked proximal tortuosity, calcified lesions, and bifurcation lesions.
  • No significant difference in 1-year mortality was observed between patients with failed TA (6.2%) and successful TA (6.4%).

Conclusions:

  • Tortuous, calcified, and bifurcation lesions are significant predictors of thrombus aspiration failure.
  • Despite technical challenges, unsuccessful thrombus aspiration does not appear to adversely affect long-term patient survival.
Abstract

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