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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.).
Insights
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.
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.
Background:
The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is uncertain. We aimed to evaluate whether thrombus aspiration reduces mortality.
Methods:
We conducted a multicenter, prospective, randomized, controlled, open-label clinical trial, with enrollment of patients from the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and end points evaluated through national registries. A total of 7244 patients with STEMI undergoing PCI were randomly assigned to manual thrombus aspiration followed by PCI or to PCI only. The primary end point was all-cause mortality at 30 days.
Results:
No patients were lost to follow-up. Death from any cause occurred in 2.8% of the patients in the thrombus-aspiration group (103 of 3621), as compared with 3.0% in the PCI-only group (110 of 3623) (hazard ratio, 0.94; 95% confidence interval [CI], 0.72 to 1.22; P=0.63). The rates of hospitalization for recurrent myocardial infarction at 30 days were 0.5% and 0.9% in the two groups, respectively (hazard ratio, 0.61; 95% CI, 0.34 to 1.07; P=0.09), and the rates of stent thrombosis were 0.2% and 0.5%, respectively (hazard ratio, 0.47; 95% CI, 0.20 to 1.02; P=0.06). There were no significant differences between the groups with respect to the rate of stroke or neurologic complications at the time of discharge (P=0.87). The results were consistent across all major prespecified subgroups, including subgroups defined according to thrombus burden and coronary flow before PCI.
Conclusions:
Routine thrombus aspiration before PCI as compared with PCI alone did not reduce 30-day mortality among patients with STEMI. (Funded by the Swedish Research Council and others; ClinicalTrials.gov number, NCT01093404.).
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