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Published on: May 28, 2019
[Effect of thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment
Insights
Thrombus aspiration during primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients showed similar clinical event rates compared to PPCI alone. Recurrent angina was more frequent with aspiration, but major adverse cardiac events did not differ significantly.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt reperfusion therapy.
- Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for STEMI.
- Thrombus aspiration during PPCI aims to improve outcomes by removing intracoronary thrombus.
Purpose of the Study:
- To evaluate the impact of adding thrombus aspiration to PPCI on clinical outcomes in STEMI patients.
- To compare the incidence of major adverse cardiac events and procedural success between PPCI alone and PPCI with aspiration.
Main Methods:
- Retrospective analysis of 321 STEMI patients undergoing PPCI.
- Patients were divided into two groups: PPCI alone (189) and PPCI with thrombus aspiration (132).
- Clinical data, procedural characteristics, and follow-up events (death, re-infarction, revascularization, angina, stent thrombosis) were analyzed.
Main Results:
- No significant difference in primary endpoint events (all-cause death, re-MI, revascularization) between groups (17.1% vs. 16.9%, P=0.962).
- Higher rates of recurrent angina in the aspiration group (25.6% vs. 16.3%, P=0.044).
- No significant differences in cardiac death, target lesion revascularization, or stent thrombosis.
Conclusions:
- Thrombus aspiration during PPCI in STEMI patients did not significantly alter the incidence of major clinical events compared to PPCI alone.
- The number of diseased vessels and postoperative TIMI flow grade were identified as risk factors for revascularization and major events.
- While aspiration did not increase major adverse events, it was associated with a higher rate of recurrent angina.
Abstract:
Objective: To investigate the effect of thrombus aspiration during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: This retrospective study included 321 STEMI patients who underwent PPCI at Beijing Chaoyang hospital from January 2013 to March 2014. Patients were divided into the PPCI group (189 cases) and the PPCI plus thrombus aspiration group (132 cases). Baseline and perioperative clinical data, procedural characteristics were collected, and primary endpoint events including all-cause death, re-myocardial infarction, and coronary revascularization and secondary endpoint events including cardiac death, recurrent angina, target lesion revascularization, and stent thrombosis were recorded during the follow-up. Results: There were no significant difference between PPCI group and PPCI plus aspiration group in age ((59.8±12.5) years old vs. (58.3±14.4) years old, P=0.060) and male ratio (82.5% (156/189) vs. 82.6% (109/132), P=0.993). The number of disease vessels (1.59±0.81 vs. 1.47±0.70, P=0.039) and the prevalence of left anterior descending as infarction related artery (52.3% (69/132) vs. 38.6% (73/189), P=0.022) were significantly higher in the PPCI plus aspiration group than that in the PPCI group.The symptom onset time (3.0 (2.0,4.8) hours vs. 4.0 (2.0,7.0) hours, P=0.027) and myocardial ischemia time (3.9 (2.7,6.2) hours vs. 4.7 (2.9,7.9) hours, P=0.022) were significantly in the PPCI plus aspiration group than in the PPCI group. The percent of thrombolysis in myocardial infarction (TIMI) thrombosis score≥ grade 4 (92.4% (122/132) vs. 75.1% (142/189), P<0.001)and postoperative TIMI flow grade 3 (70.5% (93/132) vs. 60.8% (115/189), P=0.003) was significantly higher in the PPCI plus aspiration group than in the PPCI group. The PPCI group patients were followed up for (31.6±7.5) months, and PPCI plus aspiration group patients were followed up for (32.2±6.7) months (P=0.466). During the follow-up period, there was no significant difference in the incidence of primary endpoint events between the PPCI plus aspiration group and the PPCI group (17.1% (22/129) vs. 16.9% (31/184), P=0.962). Recurrent angina was more frequent in the PPCI plus aspiration group than in the PPCI group (25.6% (33/129) vs. 16.3% (30/184), P=0.044). There was no significant difference in cardiac death (3.1% (4/129) vs. 3.3% (6/184), P=1.000), target lesion revascularization (3.9% (5/129) vs. 3.3% (6/184), P=0.765), and stent thrombosis (3.1% (4/129) vs. 2.7% (5/184), P=1.000) between the PPCI plus aspiration group and the PPCI group. Multivariate Cox regression analysis showed that the number of diseased vessels (RR=1.901, 95%CI 1.217-2.970, P=0.005) and postoperative TIMI flow grade (RR=0.455, 95%CI 0.221-0.934, P=0.032) were the risk factors for coronary revascularization after PPCI. The number of diseased vessels was a risk factor for major endpoint events after PPCI (RR=1.421, 95%CI 1.017-1.986, P=0.040). Conclusion: The incidence of clinical events is similar in patients with STEMI treated with PPCI alone or PPCI plus aspiration.
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