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Published on: May 28, 2019
Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial
Kevin Rajakariar1, Nick Andrianopoulos2, Daniel Gayed1
1Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia.
Insights
Routine intracoronary thrombus aspiration (TA) in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) did not improve mortality. While TA reduced 30-day major adverse cardiovascular events, it did not impact long-term survival.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Previous trials on routine intracoronary thrombus aspiration (TA) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) yielded unclear benefits.
- This study investigates the efficacy of manual TA as an adjunct to primary PCI.
Purpose of the Study:
- To determine if manual thrombus aspiration prior to PCI impacts outcomes in STEMI patients compared to PCI alone.
- To analyze the association between TA use and 30-day MACCE and long-term mortality.
Main Methods:
- Retrospective analysis of 6270 STEMI patients undergoing primary PCI from the Melbourne Interventional Group registry (2007-2018).
- Comparison of outcomes between 1621 patients who received TA and 4649 patients who underwent PCI alone.
- Multivariable analysis to identify predictors of 30-day MACCE and long-term mortality.
Main Results:
- Patients receiving TA were more likely to be younger, male, current smokers, and have complex lesions with TIMI 0 flow.
- No significant differences were observed in post-procedural TIMI flow, stroke, or mortality between the groups.
- Multivariable analysis revealed a reduction in 30-day MACCE (HR 0.75) with TA, but no association with long-term mortality (HR 0.98).
Conclusions:
- Intracoronary thrombus aspiration in STEMI patients undergoing primary PCI is not associated with improved short-term or long-term mortality compared to PCI alone.
- The observed reduction in 30-day MACCE with TA warrants further investigation into its clinical significance.
Background:
Previous large multi-centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).
Aim:
To determine whether there is a difference in outcomes with the use of manual TA prior to PCI, compared with PCI alone in a cohort of patients with STEMI.
Methods:
We analysed data from 6270 consecutive patients undergoing primary PCI for STEMI prospectively enrolled in the Melbourne Interventional Group registry between 2007 and 2018. Multivariable analysis was performed to determine predictors of 30-day major adverse cardiovascular and cerebrovascular events (MACCE) and long-term mortality.
Results:
We compared 1621 (26%) patients undergoing primary PCI with TA to 4649 (74%) patients undergoing PCI alone. Male gender (81% vs 78%; P < 0.01), younger age (61 vs 63 years; P = 0.03), GP-IIb/IIIa use (76% vs 58%, P < 0.01), and current smoking (40% vs 36%; P < 0.01) were more common in the TA group. TA was more likely to be used in patients with complex lesions (83% vs 66%; P < 0.01) with TIMI 0 flow (77% vs 56%; P < 0.01). No significant difference in post-procedural TIMI flow, stroke, 30-day mortality, or long-term mortality were identified. Multivariable analysis demonstrated a reduction in 30-day MACCE (hazard ratio (HR) 0.75; confidence interval (CI) 0.63-0.89; P < 0.01) in the TA group, but was not associated with long-term mortality (HR 0.98; CI 0.85-1.1; P = 0.73).
Conclusion:
The use of TA in patients undergoing primary PCI for STEMI was not associated with improved short or long-term mortality when compared with PCI alone.
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