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Evaluation of thrombus aspiration during primary PCI in STEMI patients

Clinical impact of thrombus aspiration during primary PCI: results from Korea acute myocardial infarction registry

1. Chonnam National University Hospital, Gwangju, Republic of Korea; 2. Sapporo Higash Tokushukai Hospital / Shonan-Kamakura General Hospital, Sapporo, Japan

Aims: The role of TA as an adjunct to percutaneous coronary intervention (PCI) remains a matter of controversy. The aim of this study is whether thrombus aspiration (TA) during PCI can add benefit to patients with acute ST-elevation myocardial infarction (STEMI).

Methods and results: Of 2,105 patients enrolled in the nationwide prospective Korea Acute Myocardial Infarction Registry from December 2007 to October 2010, a cohort of 745 (35.4%) patients who underwent TA during PCI was compared with 1,360 (64.6%) patients who underwent conventional PCI without TA. Clinical outcomes at 12-month of overall enrolled patients and subgroups according to key baseline clinical and procedural variables were assessed using Cox regression models adjusted by propensity score. Although the proportion of non-fatal myocardial infarction was significantly lower in TA group than non-TA group (non-TA group: 2.2%, TA group: 0.7%, p=0.010) in unadjusted analysis, multivariate analyses showed no differences in clinical outcomes. In subgroup analyses, administration of glycoprotein (GP) IIb/IIIa inhibitors during primary PCI [adjusted hazard ratio (HR) 0.329, 95% confidence interval (CI) 0.126 to 0.860, p=0.023], combined use of intravascular ultrasound (IVUS) (adjusted HR 0.296, 95% CI 0.090 to 0.975, p=0.045) and left anterior descending (LAD) as culprit lesion (adjusted HR 0.516, 95% CI 0.275 to 0.971, p=0.040) were the settings, in which TA was associated with a lower major adverse cardiac events (MACE) rate compared with non-TA.

Conclusions: Although TA does not improve clinical outcomes in overall STEMI patients who underwent primary PCI, the use of TA for LAD occlusion improves 12-month MACE. Furthermore, combination therapy IVUS and GP IIb/IIIa inhibitors with TA have synergetic effect on clinical outcomes.

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