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Outcome of thrombus aspiration in STEMI patients: a propensity score-adjusted study

Johannes Blumenstein1, Steffen Daniel Kriechbaum2, Jürgen Leick1

  • 1Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.

Journal of Thrombosis and Thrombolysis
|December 24, 2017
PubMed

Insights

Thrombus aspiration before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients showed higher in-hospital mortality but similar long-term survival. However, thrombus aspiration reduced rehospitalization rates and improved Canadian Cardiovascular Society grading during follow-up.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Thrombus aspiration (TA) before primary percutaneous coronary intervention (PPCI) is a debated strategy in ST-segment elevation myocardial infarction (STEMI).
  • Clinical implications and long-term outcomes of TA in STEMI patients remain under investigation despite guideline changes.

Purpose of the Study:

  • To investigate the clinical effects and outcomes of thrombus aspiration (TA) prior to primary percutaneous coronary intervention (PPCI) in patients with STEMI.
  • To compare in-hospital and long-term mortality, as well as secondary endpoints, between TA and conventional PPCI groups.

Main Methods:

  • Retrospective, propensity score-adjusted, multicenter study analyzing 1027 patients with STEMI.
  • Patients were divided into a thrombus aspiration (TA) group (418 patients) and a conventional PPCI group (609 patients).
  • Primary endpoints included in-hospital and long-term mortality; secondary endpoints included cardiovascular death, reinfarction, flow-grade, ejection fraction, rehospitalization, and CCS grading.

Main Results:

  • In-hospital mortality was significantly higher in the TA group (8.7% vs. 5.0%, P=0.03).
  • Long-term mortality rates were similar between groups (TA 14.3% vs. PPCI 15.0%, P=0.85), with no significant benefit of TA shown in survival analysis.
  • Rehospitalization rates (1.82% vs. 10.3%, P<0.0001) and Canadian Cardiovascular Society (CCS) grading (P=0.02) were significantly lower in the TA group during follow-up.

Conclusions:

  • While thrombus aspiration in STEMI patients was associated with higher in-hospital mortality, long-term mortality rates did not differ significantly compared to conventional PPCI.
  • Thrombus aspiration demonstrated a significant reduction in rehospitalization rates and improved CCS grading during the long-term follow-up period.
  • The findings suggest a complex risk-benefit profile for TA in STEMI, with potential benefits in reducing subsequent hospitalizations despite initial mortality concerns.

Keywords:
Acute myocardial infarctionLeft ventricular functionPCIPropensity score adjustmentRehospitalizationThrombus aspiration

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