Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction

• Published in: The New England journal of medicine Vol. 369; no. 17; pp. 1587 - 1597
• Main Authors: Fröbert, Ole, Lagerqvist, Bo, Olivecrona, Göran K, Omerovic, Elmir, Gudnason, Thorarinn, Maeng, Michael, Aasa, Mikael, Angerås, Oskar, Calais, Fredrik, Danielewicz, Mikael, Erlinge, David, Hellsten, Lars, Jensen, Ulf, Johansson, Agneta C, Kåregren, Amra, Nilsson, Johan, Robertson, Lotta, Sandhall, Lennart, Sjögren, Iwar, Östlund, Ollie, Harnek, Jan, James, Stefan K
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 24.10.2013
• Subjects: Aged; Angiography; Angioplasty; Biological and medical sciences; Blood clots; Cardiac and Cardiovascular Systems; Cardiology and Cardiovascular Disease; Cardiology. Vascular system; Cardiovascular disease; Cerebral infarction; Clinical Medicine; Clinical trials; Combined Modality Therapy; Consent; Coronary heart disease; Coronary Thrombosis - therapy; Electrocardiography; Fees & charges; Female; General aspects; Heart; Heart attacks; Heart failure; Hospitals; Humans; Implants; Kardiologi; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Male; Medical and Health Sciences; Medical imaging; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Neurological complications; Patients; Percutaneous Coronary Intervention; Prospective Studies; Recurrence; Research centers; Suction; Thrombectomy - instrumentation; Thrombectomy - methods; Thrombosis; Time-to-Treatment; Denmark; Sweden; Myocardial infarction; Medicine; ST elevation; Aspiration; Cardiovascular disease; Coronary heart disease; Myocardial disease
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1308789

The infrastructure of an established PCI registry was used to conduct a randomized trial comparing manual thrombus aspiration before PCI with PCI alone in patients with STEMI. There was no significant difference between the two groups in mortality at 30 days. One of the most important therapeutic challenges in the management of ST-segment elevation myocardial infarction (STEMI) is the establishment of normal coronary blood flow after percutaneous coronary intervention (PCI). Reduced flow is closely associated with reperfusion injury, 1 which can lead to arrhythmias, contractile dysfunction, microvascular impairment, and irreversible myocardial damage. 2 Reduced myocardial perfusion is also associated with heart failure and death. 3 , 4 Coronary-artery thrombus aspiration, a simple, rapidly performed, and relatively inexpensive adjunct to PCI, may improve blood flow and resolution of ST-segment elevation, 5 – 9 although this is not a universal finding. 10 – 12 Previous studies of thrombus aspiration have not . . .