The effect of thrombus aspiration during primary percutaneous coronary intervention on clinical outcome in daily clinical practice

Abstract

It was the purpose of this study to assess the effect of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) on reperfusion and clinical outcome in a real-world STEMI population. The decision to use TA (Export catheter, Medtronic) was at the discretion of the treating cardiologist. The primary endpoint was mortality at short (in-hospital) and long term (one year) follow-up. Secondary end points were post-PCI TIMI flow, residual ST deviation and enzymatic infarct size. Cox proportional hazard models (propensity-weighted) and logistic regression analysis were used to adjust for known covariates, associated with mortality. We performed a retrospective analysis of prospectively collected data on 2,552 consecutive PPCI-treated STEMI patients between 2007 and 2010. Use of TA increased from 6.9% in 2007 to 62.2% in 2010 (p<0.001). TA was performed in 899 patients (35.2%). In-hospital and one-year mortality rates were 3.0% and 6.0%, respectively, in the TA group and 3.5% and 7.6% in the no-TA group. After multivariate analysis, TA was not significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 0.70; 95% confidence interval [CI]: 0.33-1.49, p=0.36) nor one year mortality (adjusted hazard ratio [HR]: 0.75, 95%CI: 0.47-1.20, p=0.23) or cardiac mortality (HR: 0.81; 95%CI: 0.45-1.46, p=0.49). After matching on the propensity score, the HR in the TA group for one year mortality was 0.70 (95%CI: 0.41-1.20, p=0.19) and for one-year cardiac mortality 0.70 (95%CI: 0.36-1.34, p=0.28). In conclusion, no significant relationship of TA with one of the secondary end points was found. The use of TA increased over the last years but clinical outcome was similar in both groups (TA vs no-TA) in this large cohort of real-world, unselected STEMI patients.

Thrombus aspiration in ST-elevation myocardial infarction: Does it actually impact long-term outcome?

“…In a recent investigation [20] including 1,035 consecutive patients, manual aspiration, performed in the 18.3%, was associated with no difference in outcome at 30-day and 1-year, respectively. Similar results were reported by Kilic et al [21]. On the contrary, in two large real world registries, thrombus aspiration was associated with long-term clinical benefit [22,23].…”

A mechanism for stroke complicating thrombus aspiration

“…Initially it was associated with decreased mortality in randomized trials and meta‐analyses . More recently, larger trials , meta‐analyses , and large registries with over 27,000 patients have found no improvement in clinical endpoints with CTA. As a consequence, updated STEMI guidelines downgraded routine CTA in STEMI from a Class IIa recommendation to a Class III recommendation .…”

Effect of Coronary Thrombus Aspiration During Primary Percutaneous Coronary Intervention on One-Year Survival (from the FAST-MI 2010 Registry)

“…These findings are also consistent with the observational data recently published from the Swedish Angiography and Angioplasty Registry and Zwolle groups. 15,16 From a pathophysiological standpoint, several studies have suggested that thrombectomy improved myocardial perfusion and reduced left ventricular remodeling by reducing micro vascular damage, 4,21,22 leading to reduced infarct size and a potentially beneficial effect on clinical outcomes. Likewise, the Thrombectomy With Export Catheter in Infarct-Related Artery During Primary Percutaneous Coronary Intervention randomized trial, using contrast-enhanced magnetic resonance imaging, demonstrated that microvascular obstruction extent was significantly lower in patients with TA at the acute stage, resulting in significantly lower infarct size at 3 months.…”