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

• Published in: Journal of thrombosis and thrombolysis Vol. 45; no. 2; pp. 240 - 249
• Main Authors: Blumenstein, Johannes, Kriechbaum, Steffen Daniel, Leick, Jürgen, Meyer, Alexander, Kim, Won-Keun, Wolter, Jan Sebastian, Abu-Samra, Maisun, Weipert, Kay, Bayer, Matthias, Dörr, Oliver, Walther, Claudia, Hamm, Christian W., Nef, Holger, Liebetrau, Christoph, Möllmann, Helge
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2018; Springer Nature B.V
• Subjects: Blood clots; Cardiology; Electrocardiography; Heart; Heart attacks; Hematology; Medicine; Medicine & Public Health; Mortality; Myocardial infarction; Survival analysis; Thrombolysis; Thrombosis; Ventricle; Thrombus aspiration; Propensity score adjustment; Rehospitalization; Acute myocardial infarction; PCI; Left ventricular function
• ISSN: 0929-5305; 1573-742X
• DOI: 10.1007/s11239-017-1601-2

The use of thrombus aspiration (TA) prior to primary percutaneous coronary intervention (PPCI) has undergone a radical change in intervention guidelines. The clinical implications, however, are still under scrutiny. This study investigated the clinical effects and outcome of TA before PPCI in patients with ST-segment elevation myocardial infarction (STEMI). Overall 1027 patients with STEMI were analyzed in this retrospective, propensity score-adjusted, multicenter study. The primary endpoints were in-hospital and long-term mortality. There were 418 patients in the TA group and 609 in the conventional PPCI group. The in-hospital mortality rate was significantly higher in the TA group (8.7 vs. 5.0%; P  = 0.03). During long-term follow-up [median follow-up duration 689 days (IQR 405–959)] the mortality rates were similar (TA 14.3%, conventional PPCI 15.0%; P  = 0.85). Survival analysis for the complete observation period revealed no significant benefit of TA [hazard ratio (HR) 1.12; 97.5% CI 0.90–0.71; P  = 0.63]. There were also no significant differences between the groups in the following secondary endpoints: composite of cardiovascular death and non-fatal reinfarction at discharge ( P  = 0.39), post-PPCI thrombolysis in myocardial infarction flow-grade-3 ( P  = 0.14), left ventricular ejection fraction ( P  = 0.47), and non-fatal reinfarction during follow-up ( P  = 0.17). Rehospitalization rate (1.82 vs. 10.3%; P  < 0.0001) and Canadian Cardiovascular Society (CCS) grading ( P  = 0.02) during follow-up were significantly lower in the TA group. In our cohort the in-hospital mortality rate was significantly higher for TA patients, but during long-term follow-up the mortality rates did not differ. The incidence of rehospitalization and CCS grading were lower in the TA-treated patients.