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Manual thrombus aspiration during primary percutaneous coronary intervention: Impact of total ischemic time
Doo Sun Sim1, Myung Ho Jeong1, Youngkeun Ahn1
1Chonnam National University Hospital, Gwangju, Republic of Korea.
Insights
Manual thrombus aspiration (TA) during percutaneous coronary intervention (PCI) did not improve outcomes. However, TA may benefit patients with 4-6 hours of ischemic time, showing a U-shaped relationship with outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- The clinical benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is uncertain.
- The influence of total ischemic time on the efficacy of TA has not been thoroughly evaluated.
Purpose of the Study:
- To investigate the 12-month clinical outcomes of manual TA combined with primary PCI in STEMI patients.
- To assess the impact of TA in relation to varying durations of total ischemic time.
Main Methods:
- Analysis of 5641 STEMI patients (<12h) from the Korea Acute Myocardial Infarction Registry undergoing primary PCI.
- Comparison of 12-month outcomes between TA (n=1245) and PCI-only (n=4396) groups, utilizing propensity matching.
- Subgroup analysis based on total ischemic time (≤2h, 2-4h, 4-6h, >6h).
Main Results:
- Overall, 12-month rates of death and major adverse cardiac events (MACE) were similar between TA and PCI-only groups.
- After propensity matching, no significant differences in 12-month outcomes were observed between the groups.
- A U-shaped relationship was noted: TA was associated with lower death and MACE rates in patients with 4-6 hours of ischemic time (p for interaction=0.01).
Conclusions:
- Manual TA during primary PCI does not generally improve 12-month clinical outcomes in STEMI patients.
- The efficacy of TA may be time-dependent, potentially offering benefits in specific ischemic time windows (4-6 hours).
Background:
The benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) remains uncertain, and the effect of TA in relation to total ischemic time has not been evaluated.
Methods:
We analyzed 5641 patients with ST-elevation myocardial infarction (STEMI) (<12h) from the Korea Acute Myocardial Infarction Registry undergoing primary PCI. Patients were divided into 2 groups: TA (n=1245) and PCI only (n=4396). Propensity-matched 12-month clinical outcome was compared between the groups according to different total ischemic times (≤2h, 2-4h, 4-6h, >6h).
Results:
Twelve-month rates of death and major adverse cardiac events (MACE: composite of death, recurrent myocardial infarction, target-vessel revascularization, and coronary artery bypass grafting) were not different between TA and PCI only. After propensity matching (n=1162 for each group), there were no differences in the 12-month outcome between TA and PCI only, which was consistent across subgroups. In the propensity-matched cohort, the effect of TA on 12-month outcome showed a U-shaped relationship with longer total ischemic time: TA in patients with total ischemic time between 4 and 6h was associated with lower rates of death [hazard ratio (HR): 0.53, 95% confidence interval (CI): 0.24-1.19, p for interaction=0.01] and MACE (HR: 0.28, 95% CI: 0.12-0.66, p for interaction=0.01).
Conclusions:
Manual TA during primary PCI was not associated with improved clinical outcome at 12 months. The impact of TA may become clinically relevant with longer total ischemic time, forming a U-shaped relationship.
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