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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
The impact of intracoronary thrombus aspiration on STEMI outcomes
Sa'ar Minha1, Ran Kornowski, Hana Vaknin-Assa
1Cardiology Department, Assaf-Harofeh Medical Center, Zerifin, and Sackler, Faculty of Medicine, Tel-Aviv University, Israel.
Insights
Manual coronary thrombus aspiration in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) showed no overall benefit. However, aspiration improved outcomes in specific STEMI subgroups with large jeopardized myocardium.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Acute Coronary Syndromes
Background:
- Manual coronary thrombus aspiration was previously linked to better outcomes in ST-elevation myocardial infarction (STEMI) patients.
- Real-world outcomes of aspiration during primary percutaneous coronary intervention (PPCI) require evaluation.
Purpose of the Study:
- To assess the effectiveness of manual coronary thrombus aspiration in STEMI patients undergoing PPCI.
- To compare outcomes between aspiration (ASP) and standard (STD) therapy in a real-world setting.
Main Methods:
- A cohort of 1035 STEMI patients with initial Thrombolysis in Myocardial Infarction (TIMI) flow grade 0/1 undergoing PPCI were analyzed.
- Patients were divided into aspiration (ASP) and standard (STD) therapy groups.
- Clinical endpoints included 30-day and 1-year mortality and major adverse cardiovascular events (MACE).
Main Results:
- No significant differences in 30-day or 1-year mortality or MACE were observed between ASP and STD groups.
- ASP patients were younger and had a higher incidence of direct stenting.
- A significant benefit of aspiration was noted in patients with proximal culprit lesions, anterior infarcts, and right ventricular involvement.
Conclusions:
- Manual thrombus aspiration during PPCI did not demonstrate overall improved clinical outcomes in STEMI patients.
- Aspiration may offer sustained clinical benefits in specific STEMI patient subgroups with extensive myocardial damage.
Background:
Manual coronary thrombus aspiration was associated with improved outcomes of ST-elevation myocardial infarction (STEMI) patients. We aimed to evaluate the outcome of aspiration in a "real-world" setting of primary percutaneous coronary intervention (PPCI).
Methods And Materials:
We analyzed the outcome of STEMI patients who underwent PPCI (initial Thrombolysis in Myocardial Infarction flow grade 0/1), comparing patients who underwent aspiration (ASP) to those who had standard (STD) therapy. Various subgroups outcomes were further analyzed. Clinical end points included mortality and major adverse cardiovascular events (MACE) at 30 days and at 1 year.
Results:
One thousand thirty-five consecutive patients were included: 189 (18.26%) with ASP and 846 (81.74%) with STD. ASP patients were younger (58±12 vs. 61±13, P<.05) and had higher incidence of direct stenting compared to STD patients (34% vs. 16.7%, P<.05). No significant differences were noted in the outcome of ASP vs. STD at 30 days (mortality rate 4.2% vs. 4.5%, P=.9; MACE 6.9% vs. 9.8%, P=.2) and at 1 year (mortality rate 8.0% vs. 8.3%, P=.9; MACE 20.0% vs. 22.3%, P=.5). A significant advantage in favor of ASP was evident in patients with proximal culprit lesions, anterior infarcts, and right ventricular involvement.
Conclusions:
Although this was largely a negative study, when STEMI involved a large jeopardized myocardium, aspiration was associated with sustained improved clinical outcomes.
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