Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction
Background: Previous large multi-centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Aim: To determine wh...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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WILEY
2023
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93766 |
| _version_ | 1848765783998464000 |
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| author | Rajakariar, K. Andrianopoulos, N. Gayed, D. Liang, D. Backhouse, B. Ajani, A.E. Duffy, S.J. Brennan, A. Roberts, L. Reid, Christopher Oqueli, E. Clark, D. Freeman, M. |
| author_facet | Rajakariar, K. Andrianopoulos, N. Gayed, D. Liang, D. Backhouse, B. Ajani, A.E. Duffy, S.J. Brennan, A. Roberts, L. Reid, Christopher Oqueli, E. Clark, D. Freeman, M. |
| author_sort | Rajakariar, K. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: Previous large multi-centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Aim: To determine whether there is a difference in outcomes with the use of manual TA prior to PCI, compared with PCI alone in a cohort of patients with STEMI. Methods: We analysed data from 6270 consecutive patients undergoing primary PCI for STEMI prospectively enrolled in the Melbourne Interventional Group registry between 2007 and 2018. Multivariable analysis was performed to determine predictors of 30-day major adverse cardiovascular and cerebrovascular events (MACCE) and long-term mortality. Results: We compared 1621 (26%) patients undergoing primary PCI with TA to 4649 (74%) patients undergoing PCI alone. Male gender (81% vs 78%; P < 0.01), younger age (61 vs 63 years; P = 0.03), GP-IIb/IIIa use (76% vs 58%, P < 0.01), and current smoking (40% vs 36%; P < 0.01) were more common in the TA group. TA was more likely to be used in patients with complex lesions (83% vs 66%; P < 0.01) with TIMI 0 flow (77% vs 56%; P < 0.01). No significant difference in post-procedural TIMI flow, stroke, 30-day mortality, or long-term mortality were identified. Multivariable analysis demonstrated a reduction in 30-day MACCE (hazard ratio (HR) 0.75; confidence interval (CI) 0.63–0.89; P < 0.01) in the TA group, but was not associated with long-term mortality (HR 0.98; CI 0.85–1.1; P = 0.73). Conclusion: The use of TA in patients undergoing primary PCI for STEMI was not associated with improved short or long-term mortality when compared with PCI alone. |
| first_indexed | 2025-11-14T11:40:45Z |
| format | Journal Article |
| id | curtin-20.500.11937-93766 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:40:45Z |
| publishDate | 2023 |
| publisher | WILEY |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-937662024-01-10T02:47:16Z Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction Rajakariar, K. Andrianopoulos, N. Gayed, D. Liang, D. Backhouse, B. Ajani, A.E. Duffy, S.J. Brennan, A. Roberts, L. Reid, Christopher Oqueli, E. Clark, D. Freeman, M. Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine thrombectomy thrombus aspiration STEMI primary PCI NO-REFLOW THROMBECTOMY ANGIOPLASTY REPERFUSION ABCIXIMAB THERAPY TIME PCI STEMI primary PCI thrombectomy thrombus aspiration Humans Male Middle Aged Coronary Thrombosis Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Thrombectomy Treatment Outcome Clinical Trials as Topic Humans Coronary Thrombosis Treatment Outcome Thrombectomy Middle Aged Male Clinical Trials as Topic Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Background: Previous large multi-centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Aim: To determine whether there is a difference in outcomes with the use of manual TA prior to PCI, compared with PCI alone in a cohort of patients with STEMI. Methods: We analysed data from 6270 consecutive patients undergoing primary PCI for STEMI prospectively enrolled in the Melbourne Interventional Group registry between 2007 and 2018. Multivariable analysis was performed to determine predictors of 30-day major adverse cardiovascular and cerebrovascular events (MACCE) and long-term mortality. Results: We compared 1621 (26%) patients undergoing primary PCI with TA to 4649 (74%) patients undergoing PCI alone. Male gender (81% vs 78%; P < 0.01), younger age (61 vs 63 years; P = 0.03), GP-IIb/IIIa use (76% vs 58%, P < 0.01), and current smoking (40% vs 36%; P < 0.01) were more common in the TA group. TA was more likely to be used in patients with complex lesions (83% vs 66%; P < 0.01) with TIMI 0 flow (77% vs 56%; P < 0.01). No significant difference in post-procedural TIMI flow, stroke, 30-day mortality, or long-term mortality were identified. Multivariable analysis demonstrated a reduction in 30-day MACCE (hazard ratio (HR) 0.75; confidence interval (CI) 0.63–0.89; P < 0.01) in the TA group, but was not associated with long-term mortality (HR 0.98; CI 0.85–1.1; P = 0.73). Conclusion: The use of TA in patients undergoing primary PCI for STEMI was not associated with improved short or long-term mortality when compared with PCI alone. 2023 Journal Article http://hdl.handle.net/20.500.11937/93766 10.1111/imj.15828 English http://purl.org/au-research/grants/nhmrc/1111170 http://purl.org/au-research/grants/nhmrc/1045862 WILEY restricted |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine thrombectomy thrombus aspiration STEMI primary PCI NO-REFLOW THROMBECTOMY ANGIOPLASTY REPERFUSION ABCIXIMAB THERAPY TIME PCI STEMI primary PCI thrombectomy thrombus aspiration Humans Male Middle Aged Coronary Thrombosis Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Thrombectomy Treatment Outcome Clinical Trials as Topic Humans Coronary Thrombosis Treatment Outcome Thrombectomy Middle Aged Male Clinical Trials as Topic Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Rajakariar, K. Andrianopoulos, N. Gayed, D. Liang, D. Backhouse, B. Ajani, A.E. Duffy, S.J. Brennan, A. Roberts, L. Reid, Christopher Oqueli, E. Clark, D. Freeman, M. Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction |
| title | Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction |
| title_full | Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction |
| title_fullStr | Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction |
| title_full_unstemmed | Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction |
| title_short | Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction |
| title_sort | outcomes of thrombus aspiration during primary percutaneous coronary intervention for st-elevation myocardial infarction |
| topic | Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine thrombectomy thrombus aspiration STEMI primary PCI NO-REFLOW THROMBECTOMY ANGIOPLASTY REPERFUSION ABCIXIMAB THERAPY TIME PCI STEMI primary PCI thrombectomy thrombus aspiration Humans Male Middle Aged Coronary Thrombosis Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Thrombectomy Treatment Outcome Clinical Trials as Topic Humans Coronary Thrombosis Treatment Outcome Thrombectomy Middle Aged Male Clinical Trials as Topic Percutaneous Coronary Intervention ST Elevation Myocardial Infarction |
| url | http://purl.org/au-research/grants/nhmrc/1111170 http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93766 |