Adjunct Thrombus Aspiration Reduces Mortality in Patients Undergoing Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction With High-Risk Angiographic Characteristics

Aamir Javaid, Nauman H. Siddiqi, Daniel H. Steinberg, Ashesh N. Buch, Tina L Pinto Slottow, Probal Roy, Saquib Sammee, Teruo Okabe, William O. Suddath, Kenneth M. Kent, Lowell F. Satler, Augusto D. Pichard, Kimberly Smith, Zhenyi Xue, Joseph Lindsay, Ron Waksman*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    25 Citations (Scopus)

    Abstract

    Routine aspiration thrombectomy (AT) in percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction (STEMI) has not proved effective in randomized trials. However, in patients undergoing primary percutaneous coronary intervention with severely reduced flow or visible thrombus, AT remains an intuitively attractive option. The use of adjunctive AT in a high-risk cohort of 158 consecutive patients with STEMI and Thrombolysis In Myocardial Infarction (TIMI) 0 to 1 flow or visible thrombus on baseline angiography was examined. Of these, 80 patients underwent AT as an adjunct to primary percutaneous coronary intervention, and 78 underwent percutaneous coronary intervention without AT (non-AT). TIMI 3 flow rates, residual thrombus after percutaneous coronary intervention, and major adverse cardiac events (mortality and nonfatal Q-wave myocardial infarction) at 30 days, 6 months, and 1 year were compared. Baseline characteristics were similar between groups. The AT group more frequently achieved TIMI 3 flow after the intervention (91.3% AT vs 67.9% non-AT; p <0.001) and had less residual thrombus (7.5% AT vs 19.2% non-AT; p = 0.03). AT was associated with reduced major adverse cardiac events at 6 months (6.8% AT vs 24.0% non-AT; p = 0.004) and 1 year (16.6% AT vs 29.2% non-AT; p = 0.009), and decreased mortality rates in the AT group at 6 months (5.4% AT vs 21.3% non-AT; p = 0.004) and 1 year (7.7% AT vs 26.2% non-AT; p = 0.005). In conclusion, for patients with STEMI and TIMI 0 or 1 flow or visible thrombus on baseline angiography, AT was associated with increased TIMI 3 flow rates, decreased residual thrombus, and decreased clinical events, including mortality.

    Original languageEnglish
    Pages (from-to)452-456
    Number of pages5
    JournalAmerican Journal of Cardiology
    Volume101
    Issue number4
    DOIs
    Publication statusPublished - 15 Feb 2008

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