Aspiration versus no aspiration during primary PCI for ST-segment elevation myocardial infarction

Abstract

Abstract Objective To compare the procedural and clinical outcomes in patients with STEMI treated with PCI and manual thrombus aspiration versus PCI alone regarding mortality at 30 days (primary endpoint), TIMI flow grade, target vessel revascularization, heart failure, length of hospital stay and complications of PCI during index hospitalization (secondary endpoints). A prospective study done in the Faculty of Medicine, Alexandria Main University Hospital and ICC Hospital. Subjects 160 patients in the setting of primary PCI in the duration from January 2014 to January 2015. Patients were divided into two groups: Group 1: 80 patients with thrombus aspiration; Group 2: 80 patients with no thrombus aspiration. Methods All patients were treated with primary PCI and evaluated by echocardiography with assessment of ejection fraction. Observation to detect the occurrence of any in-hospital MACE or other PCI complications. Follow-up at 30 days for death or rehospitalization. Results The peak of post procedural CK-MB (151.8 U/L vs. 131.2 U/L, P = 0.026) was significantly lower in group 2. There was no statistically significant difference between both groups as regards pre-discharge ejection fraction (45.63 ± 10.86% vs. 42.37 ± 10.14) P = 0.171. Also there were no statistically significant differences between both groups as regards TIMI flow (P = 0.403), or incidence of no reflow (P = 0.615). Stroke perforation and cardiac tamponade did not occur in both groups. Heart failure occurred in 10 patients (12.5%) in group 1, and in 12 patients (15%) in group 2 with no statistical significance. Stent thrombosis did not occur in any patient in the two groups. Rehospitalization due to cardiac cause was less in group 1 [2 patients (2.5%)] than in group 2 [6 patients (7.5%)] with no statistical significance P = 0.615. Mortality after 30 days was the same in both groups, and 4 patients (5%) died in each group P = 1. Conclusion Thrombus aspiration had no additional benefit over conventional PCI regarding mortality, left ventricular function, length of hospital stay, rehospitalization due to cardiac cause and complications of PCI. Routine thrombus aspiration is not recommended especially in patients with low thrombus grade.