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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

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Published on: May 28, 2019

Thrombus aspiration during ST-segment elevation myocardial infarction.

Ole Fröbert¹, Bo Lagerqvist, Göran K Olivecrona

¹From the Department of Cardiology, Örebro University Hospital, Örebro (O.F., F.C.), Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala (B.L., O.O., S.K.J.), Department of Cardiology, Lund University Hospital, Lund (G.K.O., D.E., J.H.), Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (E.O., O.A.), Department of Cardiology, Karolinska Institutet, Sodersjukhuset (M.A.), and Cardiology Unit, Department of Medicine, Karolinska University Hospital (U.J.), Stockholm, Department of Cardiology, Karlstad Hospital, Karlstad (M.D.), Department of Cardiology, Gävle Hospital, Gävle (L.H.), PCI Unit, Sunderby Hospital, Sunderby (A.C.J.), Department of Cardiology, Västerås Hospital, Västerås (A.K.), Department of Cardiology, Heart Center, Umea University, Umea (J.N.), Department of Cardiology, Borås Hospital, Borås (L.R.), Department of Radiology, Helsingborg Hospital, Helsingborg (L.S.), and Department of Cardiology, Falun Hospital, Falun (I.S.) - all in Sweden; Department of Cardiology and Cardiovascular Research Center, Landspitali University Hospital of Iceland, Reykjavik, Iceland (T.G.); and Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark (M.M.).

The New England Journal of Medicine

|September 3, 2013

Summary

Routine thrombus aspiration before percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients did not reduce 30-day mortality. This large trial found no significant benefit for this intervention in STEMI care.

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Area of Science:

Cardiology
Interventional Cardiology
Acute Coronary Syndromes

Background:

The benefit of routine intracoronary thrombus aspiration prior to primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) remains unclear.
Evaluating the impact of thrombus aspiration on mortality in STEMI patients is crucial for clinical practice guidelines.

Purpose of the Study:

To determine if routine manual thrombus aspiration, preceding primary PCI, reduces all-cause mortality in patients with STEMI.
To assess the efficacy of thrombus aspiration in improving outcomes beyond PCI alone.

Main Methods:

A multicenter, prospective, randomized, controlled, open-label trial involving 7244 STEMI patients undergoing PCI.
Patients were randomized to either manual thrombus aspiration followed by PCI or PCI alone.
Outcomes were evaluated through national registries, with the primary endpoint being 30-day all-cause mortality.

Main Results:

No significant difference in 30-day all-cause mortality between the thrombus aspiration group (2.8%) and the PCI-only group (3.0%) (HR 0.94; 95% CI 0.72-1.22; P=0.63).
Rates of recurrent myocardial infarction, stent thrombosis, stroke, and neurological complications were not significantly different between the groups.
Results were consistent across prespecified subgroups, including those based on thrombus burden and initial coronary flow.

Conclusions:

Routine thrombus aspiration before primary PCI in STEMI patients does not decrease 30-day mortality compared to PCI alone.
The findings suggest that routine thrombus aspiration is not beneficial for reducing mortality in this patient population.