Manual Thrombus Aspiration and the Improved Survival of Patients With Unstable Angina Pectoris Treated With Percutaneous Coronary Intervention (30 Months Follow-Up)

Abstract

The clinical effect of intracoronary thrombus aspiration during percutaneous coronary intervention in patients with unstable angina pectoris is unknown. In this study, we aimed to assess how thrombus aspiration during percutaneous coronary intervention affects in-hospital and 30-month mortality and complications in patients with unstable angina pectoris.We undertook an observational cohort study of 645 consecutive unstable angina pectoris patients who had performed percutaneous coronary intervention from February 2011 to March 2013. Before intervention, 159 patients who had culprit lesion with thrombus were randomly assigned to group 1 (thrombus aspiration group) and group 2 (stand-alone percutaneous coronary intervention group). All patients were followed-up 30 months until August 2015.Thrombus aspiration was performed in 64 patients (46%) whose cardiac markers (ie, creatinine kinase [CK-MB] mass and troponin T) were significantly lower after percutaneous coronary intervention than in those of group 2 (CK-MB mass: 3.80 ± 1.11 vs 4.23 ± 0.89, P = 0.012; troponin T: 0.012 ± 0.014 vs 0.018 ± 0.008, P = 0.002). Left ventricular ejection fraction at 6, 12, and 24 months postintervention was significantly higher in the group 1. During a mean follow-up period of 28.87 ± 6.28 months, mortality rates were 6.3% in the group 1 versus 12.9% in the group 2. Thrombus aspiration was also associated with significantly less long-term mortality in unstable angina pectoris patients (adjusted HR: 4.61, 95% CI: 1.16–18.21, P = 0.029).Thrombus aspiration in the context of unstable angina pectoris is associated with a limited elevation in cardiac enzymes during intervention that minimises microembolization and significantly improves both of epicardial flow and myocardial perfusion, as shown by angiographic TIMI flow grade and frame count. Thrombus aspiration during percutaneous coronary intervention in unstable angina pectoris patients has better survival over a 30-month follow-up period.

Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST‐segment elevation myocardial infarction

“…TA catheter should be completely flushed with heparinized saline before use and re‐flushed before each re‐use. Application of additional predilation or postdilation procedure was based on the interventionist's decision …”

“…Application of additional predilation or postdilation procedure was based on the interventionist's decision. [24][25][26][27] All patients received oral aspirin (300 mg) and oral clopidogrel…”

The value of Sonoclot detection technology to guide the clinical medication of the perioperative anticoagulation and antiplatelet therapy in patients with acute myocardial infarction undergoing emergent PCI

“…Sonoclot detection is more convenient and time-saving, and it has better effect in improving the efficiency of perioperative anticoagulation and antiplatelet drugs. Better coagulation control could also have more benefit in reducing myocardial injury ( 15 ). Recurrence of microembolism, myocardial infarction, acute and subacute thrombosis, as well as the incidence of bleeding in observation group are significantly lower than that of control group.…”

Effect of Coronary Thrombus Aspiration in Non ST Elevation Acute Coronary Syndrome Patients on Three-Year Survival- Does it add any Benefit?

“…Thrombus was defined as the presence of a roundish filling defect of the lumen during dye injection (in multiple projections) with or without the persistence of luminal contrast following injection. 3,7 Patients who had been administered anticoagulants, and patients who presented with cardiogenic shock or thrombus formation as a complication of a PCI (eg, vessel closure after stenting) were excluded. Also, patients who had total coronary artery occlusion and no coronary thrombus were excluded.…”

“…1,3,7 The analysis included PCI patients with UAP in whom a manual aspiration catheter was applied for TA during PCI, which is rarely performed. 3,7 At the present time, there is no published data comparing the effect of TA conducted in patients with NSTEMI or UAP.…”