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Published on: January 18, 2018
Aspiration thrombectomy in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary
Mady Moriel1, Shlomi Matetzky2, Amit Segev2
1Department of Cardiology, Shaare Zedek Medical Center, The Hebrew University Hadassah Medical School, Jerusalem, Israel.
Insights
Aspiration thrombectomy (AT) in ST-elevation myocardial infarction patients undergoing primary PCI did not significantly change 30-day adverse cardiac events. However, AT was linked to lower 1-year mortality, suggesting improved long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring rapid reperfusion.
- Primary percutaneous coronary intervention (PPCI) is the standard treatment for STEMI.
- Aspiration thrombectomy (AT) is an adjunct procedure to PPCI, aiming to remove thrombus burden.
Purpose of the Study:
- To evaluate the impact of aspiration thrombectomy (AT) combined with primary percutaneous coronary intervention (PPCI) on major adverse cardiac events (MACE) at 30 days.
- To assess the effect of AT-PPCI on 1-year mortality in STEMI patients.
Main Methods:
- Prospective, nationwide, multicenter observational study including 517 STEMI patients.
- Comparison between patients undergoing AT-PPCI (n=217) and conventional PPCI (n=300).
- Analysis of baseline characteristics, procedural details, and clinical outcomes at 30 days and 1 year.
Main Results:
- Thirty-day MACE rates were similar between AT-PPCI and conventional PPCI groups (10.6% vs. 9.7%, p=0.73).
- One-year mortality was significantly lower in the AT-PPCI group compared to the conventional PPCI group (3.7% vs. 6.7%, p=0.13).
- AT was identified as an independent predictor of reduced 1-year mortality (adjusted hazard ratio 0.31, p=0.042).
Conclusions:
- Aspiration thrombectomy in conjunction with PPCI does not increase short-term MACE in STEMI patients.
- AT-PPCI is associated with a significant reduction in 1-year mortality.
- AT may be a valuable strategy for improving long-term survival in STEMI patients undergoing PPCI.
Abstract:
We assessed the impact of aspiration thrombectomy (AT) in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention (PPCI) on major adverse cardiac events at 30 days and 1-year mortality in 517 consecutive patients who were included in the prospective, nationwide, multicenter, observational Acute Coronary Syndrome Israeli Survey in 2010. Two hundred seventeen patients (42%) underwent AT (AT-PPCI) and 300 patients conventional (C) PPCI. Both groups had similar infarct-related artery distribution and ostial or proximal culprit lesion. Patients in AT-PPCI versus C-PPCI had lower systolic blood pressure and worse Killip class on admission, more frequent Thrombolysis In Myocardial Infarction flow 0 or 1 before PPCI (80% vs 56%), less frequent restoration of flow after indwelling a guidewire in the infarct-related artery (32% vs 52%), and more use of IIb/IIIa glycoprotein inhibitors (69% vs 49%), respectively (p ≤0.05 for all comparisons). Thirty-day major adverse cardiac events was similar in the AT-PPCI and C-PPCI groups, 10.6% versus 9.7%, p = 0.73; adjusted odds ratio 0.97, 95% confidence interval 0.45 to 2.10, p = 0.95. One-year mortality was lower in the AT-PPCI versus C-PPCI group, 3.7% versus 6.7%, p = 0.13; adjusted hazard ratio 0.31, 95% confidence interval 0.10 to 0.96, p = 0.042. In conclusion, this study of consecutive patients with ST elevation myocardial infarction undergoing PPCI demonstrates that AT was an independent predictor of reduced 1-year mortality.
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