open access

Vol 22, No 3 (2015)
Original articles
Published online: 2015-06-19
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Thrombus aspiration in ST-elevation myocardial infarction: Does it actually impact long-term outcome?

Serafina Valente, Alessio Mattesini, Chiara Lazzeri, Marco Chiostri, Cristina Giglioli, Francesco Meucci, Giorgio Jacopo Baldereschi, Cesare Cordopatri, Gian Franco Gensini
DOI: 10.5603/CJ.a2014.0061
·
Pubmed: 25179318
·
Cardiol J 2015;22(3):306-314.

open access

Vol 22, No 3 (2015)
Original articles
Published online: 2015-06-19

Abstract

Background: The effect of thrombus aspiration on mortality is still controversial, with results which are often inconsistent in different randomized trials, real world registries and differ­ent follow-up duration. The aim of this analysis was to assess the effect on 30-day and 1-year mortality of thrombus aspiration during primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) compared with conventional PCI.

Methods: We used data from all the consecutive STEMI patients treated either with conven­tional PCI or thrombus aspiration between January 1, 2004 and January 1, 2012. Propensity matching score was calculated on the basis of several baseline and procedural characteristics in order to predict the probability for each patient of having been treated with thrombus aspira­tion. This propensity score analysis was used in order to select a cohort of patients treated with thrombus aspiration matched one-to-one with patients treated with conventional PCI.

Results: In total, 744 (53.1%) patients out of 1,400 enrolled were treated with thrombus as­piration. In the matched cohort, at 30-day follow-up 6.3% of patients in the conventional PCI group died compared to 4.7% in the thrombus aspiration group. The unadjusted hazard ratio (HR) for 30-day mortality was 1.01 (95% CI 0.33–3.14, p = 0.985). In the same cohort, 10.7% of patients died at 1-year in the conventional PCI group compared to 5.2% in the thrombus as­piration group. The 1-year unadjusted hazard ratio for mortality was 0.47 (95% CI 0.25–0.90, p = 0.025). The HR changed and was no longer significant after adjustment for differences in the use of glycoprotein (GP) IIb/IIIa inhibitors, lesion pre-dilatation and pre-procedural TIMI flow: 0.71 (95% CI 0.36–1.39, p = 0.322).

Conclusions: Thrombus aspiration does not influence 30-day mortality, however it is associated with 1-year survival benefit. GP IIb/IIIa inhibitors and thrombus aspiration may have an important synergistic role in leading to this long-term benefit.

Abstract

Background: The effect of thrombus aspiration on mortality is still controversial, with results which are often inconsistent in different randomized trials, real world registries and differ­ent follow-up duration. The aim of this analysis was to assess the effect on 30-day and 1-year mortality of thrombus aspiration during primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) compared with conventional PCI.

Methods: We used data from all the consecutive STEMI patients treated either with conven­tional PCI or thrombus aspiration between January 1, 2004 and January 1, 2012. Propensity matching score was calculated on the basis of several baseline and procedural characteristics in order to predict the probability for each patient of having been treated with thrombus aspira­tion. This propensity score analysis was used in order to select a cohort of patients treated with thrombus aspiration matched one-to-one with patients treated with conventional PCI.

Results: In total, 744 (53.1%) patients out of 1,400 enrolled were treated with thrombus as­piration. In the matched cohort, at 30-day follow-up 6.3% of patients in the conventional PCI group died compared to 4.7% in the thrombus aspiration group. The unadjusted hazard ratio (HR) for 30-day mortality was 1.01 (95% CI 0.33–3.14, p = 0.985). In the same cohort, 10.7% of patients died at 1-year in the conventional PCI group compared to 5.2% in the thrombus as­piration group. The 1-year unadjusted hazard ratio for mortality was 0.47 (95% CI 0.25–0.90, p = 0.025). The HR changed and was no longer significant after adjustment for differences in the use of glycoprotein (GP) IIb/IIIa inhibitors, lesion pre-dilatation and pre-procedural TIMI flow: 0.71 (95% CI 0.36–1.39, p = 0.322).

Conclusions: Thrombus aspiration does not influence 30-day mortality, however it is associated with 1-year survival benefit. GP IIb/IIIa inhibitors and thrombus aspiration may have an important synergistic role in leading to this long-term benefit.

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Keywords

thrombus aspiration, percutaneous coronary intervention, ST elevation myocardial infarction, glycoprotein IIb/IIIa inhibitors

About this article
Title

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

Journal

Cardiology Journal

Issue

Vol 22, No 3 (2015)

Pages

306-314

Published online

2015-06-19

DOI

10.5603/CJ.a2014.0061

Pubmed

25179318

Bibliographic record

Cardiol J 2015;22(3):306-314.

Keywords

thrombus aspiration
percutaneous coronary intervention
ST elevation myocardial infarction
glycoprotein IIb/IIIa inhibitors

Authors

Serafina Valente
Alessio Mattesini
Chiara Lazzeri
Marco Chiostri
Cristina Giglioli
Francesco Meucci
Giorgio Jacopo Baldereschi
Cesare Cordopatri
Gian Franco Gensini

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