Thrombus Aspiration Group Research Articles

Thrombus aspiration in primary percutaneous coronary intervention in acute ST-elevation myocardial infarction patients with high thrombus burden: one-year outcomes in a tertiary healthcare center in Ho Chi Minh City

Abstract Background Primary percutaneous coronary intervention (PCI) can dislodge atherosclerotic debris, risking microvascular embolism. Thrombus aspiration (TA) before stenting in ST-segment elevation myocardial infarction (STEMI) patients has been linked to reduced mortality, lower recurrence of heart attacks, and improved cardiac function. However, limited research exists on the effectiveness of TA in Vietnam, underscoring the need for further studies to enhance cardiovascular care. This prospective observational study was conducted to evaluate the role of TA in STEMI patients admitted with a substantial thrombus burden at Nguyen Tri Phuong Hospital. Results Out of 92 participants, 68 underwent TA treatment. Post-treatment, the TA group exhibited better TIMI and TMP flow grades and a higher rate of ST-segment normalization, with no significant difference in major adverse cardiac events (MACEs) at 30-day and 12-month follow-ups compared to those untreated. Conclusions TA during PCI enhances ST-segment normalization and TIMI and TMP scores in STEMI patients, improving myocardial perfusion. No difference in MACE occurrence was noted between groups after 30 days and 12 months, suggesting TA’s potential benefits without increasing adverse outcomes.

Value of Cardiac Magnetic Resonance Imaging in Assessment of the Myocardial Reperfusion after Primary Percutaneous Coronary Intervention with or without Thrombus Aspiration in Patients with ST-Elevation Myocardial Infarction with High Thrombus Burden

Abstract Background Primary percutaneous coronary intervention (PCI) is effective in opening the infarct related artery in patients with myocardial infarction with ST-segment elevation. However, the embolization of atherothrombotic debris induces microvascular obstruction and diminishes myocardial reperfusion. Objective The study aims to evaluate the efficacy and safety of the manual thrombus aspiration during primary PCI for the acute ST-elevation myocardial infarction (STEMI) patients with high thrombus burden. Patients and Methods The current study was prospective cohort study which was conducted on 100 patients presenting to cardiology department in Ain Shams University hospitals with STEMI in the first 12 hours of presentation, comparing two group (50 patients in each group): the thrombus aspiration group(group A) who underwent manual thrombus aspiration before the provisional stenting and the conventional PCI group (group B) who underwent provisional stenting using standard technique without thrombus aspiration.). every patient is assigned to a particular group based on the operator’s preference. The blood flow of the culprit coronary artery in the thrombolysis in myocardial infarction (TIMI) and the myocardial blush grade(MBG) was recorded immediately after the emergency PCI operation in each group, then an echocardiogram was performed to determine the left ventricular dimensions and ejection fraction within in 1 week after the operation, cardiac MRI was performed 3 months after the operation to determine the left ventricular dimensions, ejection fraction, stroke volume and size of infarction and finally the data on major adverse cardiovascular events (MACE) during the 6 months of postoperative follow-up were collected. Results There were no statistically significant differences between the two groups in terms of the demographic data, the cardiovascular risk factors, the vital data at the time of the hospital admission, the Killip class and the pain to door. The postoperative final TIMI flow was TIMI III flow in 46 patients (92%) of the thrombus aspiration group vs 34 patients (68%) in the conventional PCI group with P- value = 0.003 (statically highly significant). The final MBG was grade III in 40 patients (80%) of the thrombus aspiration group vs 30 patients (60 %) in the conventional PCI group, grade II in 10 patients (20 %) vs 16 patients (32%) and grade 0 only in 4 patients (4 %) in the conventional PCI group with P- value = 0.033 (statically significant). The post operative ECHO showed smaller Left ventricular dimensions with higher Left ventricular systolic and diastolic function in the thrombus aspiration group than the conventional PCI group with p value = 0.000 (statically highly significant). The postoperative cardiac MRI showed smaller Left ventricular end -systolic and end -diastolic volumes index with higher Left ventricular systolic function and Left ventricular Stroke volume index in the thrombus aspiration group than the conventional PCI group with p value = 0.000 (statically highly significant). Moreover, the postoperative cardiac MRI showed smaller LV Size of infarction (LV myocardia scar) in the thrombus aspiration group than the conventional PCI group with p value = 0.000 (statically highly significant).finally, there was a significant reduced rate of cardiovascular death and major adverse cardiovascular events (MACE) with no difference regarding the rate of the cerebrovascular stroke within 6 months post procedure in the thrombus aspiration group compared to the conventional PCI group with p value = 0.027 (statically significant).

Thrombus aspiration is associated with improved platelet inhibition rate following dual antiplatelet therapy in acute myocardial infarction patients

BackgroundIt is well-established that thrombus aspiration during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) indicates a higher thrombus burden and necessitates more intensive antithrombotic therapy. The bidirectional association between adverse events in AMI patients and platelet reactivity is typically observed during dual antiplatelet therapy (DAPT).ObjectiveTo investigate platelet reactivity after DAPT in AMI patients with thrombus aspiration performed during PCI.MethodsIn this retrospective study, we examined 269 consecutive AMI patients who underwent PCI and recorded their demographic, clinical and laboratory data. The platelet reactivity was measured with thromboelastogram (TEM).ResultsUltimately, 208 patients were included in this study and divided into a Thrombus Aspiration group (N = 97) and a PCI Alone group (N = 111) based on whether thrombus aspiration was performed or not. The adenosine diphosphate (ADP)-induced platelet inhibition rate in the Thrombus Aspiration group was higher than that in the PCI Alone group (P < 0.001). Furthermore, multivariate linear regression analysis revealed that the ADP-induced platelet inhibition rate was independently associated with leukocyte count, thrombus aspiration and the combination of aspirin and ticagrelor as DAPT after adjusting for potential covariates in all AMI patients.ConclusionIn conclusion, clinicians should exercise heightened attention towards the bleeding risk among patients undergoing PCI concomitant with Thrombus Aspiration postoperatively.

Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials

BackgroundRoutine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery and remodeling after STEMI remains controversial. We aimed to pool data from randomized controlled trials (RCTs) on the impact of TA on LV function and remodeling after primary percutaneous coronary intervention (pPCI). MethodsPubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA. ResultsA total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to −0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to −3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = −2.13, p = 0.03; z = −3.7, p < 0.01) and the improvement in myocardial salvage index (z = 2.04, p = 0.04). ConclusionTA is associated with improved LV function. TA technique, total ischemic time and LAD involvement appears to influence TA benefit on post-infarction LV remodeling.

Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction.

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). 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. 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. 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). 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.

Clinical effectiveness of thrombus aspiration during percutaneous coronary intervention for stent thrombosis in a contemporary setting

ObjectiveThe impact of adjunctive manual thrombus aspiration (TA) in patients with stent thrombosis (ST) treated with percutaneous intervention has not been evaluated in the current era of potent P2Y12 agents and new-generation drug-eluting stents. We sought to assess the effect of TA using data from a large contemporary registry. MethodsThe study population was derived from the Essex ST Investigation Registry (ESTHIR), which contains all consecutive cases of angiographically determined definite ST undergoing interventional treatment in a tertiary cardiac centre between November 2015 and June 2018. Propensity score matching was performed to match patients who underwent TA (TA group) to those who did not (n-TA group). The study endpoints were final TIMI flow and survival free of cardiovascular death (CD) or target lesion revascularisation (TLR). ResultsA total of 128 ST patients were included in the present analysis. The mean age was 65 ± 11 years, and 84% were male. About 90% of the patients presented with STEMI, and 85% had very late ST. Seventy-two patients (56%) underwent TA. After propensity score matching, 30 patients were included in each study group. A higher rate of final TIMI III flow was observed in the TA group (TA vs n-TA group, 100% vs 83%), but this difference did not reach statistical significance (p = 0.052). At 1000 days of follow-up, survival free of CD or TLR was not different between the two groups (p = 0.8). ConclusionIn a propensity-matched population of ST patients undergoing PCI in a contemporary setting, TA was not associated with improved final TIMI flow or long-term cardiovascular outcomes.

Age-Related Utilization of Thrombus Aspiration in Patients With ST-Segment Elevation Myocardial Infarction: Findings From the Improving Care for Cardiovascular Disease in China Project

BackgroundThere are some controversies on the utilization and benefits of thrombus aspiration in patients with ST-segment elevation myocardial infarction (STEMI). However, a few studies investigated this issue and the age-associated effects among the large population in China. Hence, we aimed to figure out the age-associated utilization and in-hospital outcomes of thrombus aspiration to improve therapeutic decisions in clinical routine.MethodsWe retrospectively recruited 13,655 eligible STEMI patients from the database of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project. These subjects were allocated into primary percutaneous coronary intervention (PPCI)-only group and thrombus aspiration group after being subdivided into three age groups (G21−50, G51−75, and G76−95). After 1:1 propensity score matching for PPCI-only and thrombus aspiration groups, a total of 8,815 matched patients were enrolled for the subsequent analysis. The primary outcome was in-hospital cardiovascular death, and the key safety outcome was in-hospital stroke.ResultsWe observed that the ratio of STEMI patients undergoing thrombus aspiration to PPCI-only reduced with aging. For patients ≤ 75 years, the culprit lesion suffered from thrombus aspiration was mainly located in the left anterior descending branch, and left-ventricular ejection fraction (LVEF) was lower (G21−50: 54.9 ± 8.9 vs. 56.0 ± 8.7%, P = 0.01; G51−75: 53.9 ± 9.6 vs. 54.8 ± 9.0%, P = 0.001) and the rate of regional wall motion abnormality was higher (G21−50: 75.7 vs. 66.5%, P < 0.001; G51−75: 75.4 vs. 69.1%, P < 0.001) in the thrombus aspiration group. By contrast, for patients > 75 years, the right coronary artery was the predominant culprit lesion undergoing thrombus aspiration, LVEF (63.1 ± 10.5 vs. 53.1 ± 9.5%, P = 0.985) and the regional wall motion abnormality (79.2 vs. 74.2%, P = 0.089) were comparable between the two treatment groups. Thrombus aspiration neither reduced the in-hospital risk of cardiovascular death, all-cause death, recurrent myocardial infarction, acute stent thrombosis, heart failure, cardiogenic shock, and sudden cardiac arrest nor increased stroke risk compared with the PPCI-only group. However, after adjustment for age, thrombus aspiration presented the tendency to reduce the incidence of sudden cardiac arrest (4.9 vs. 2.5%, P = 0.06) and in-hospital cardiovascular death at 3 days (hazard ratio 0.46; 95% CI, 0.20–1.06; log-rank P = 0.08) in G76−95 group and tended to increase the incidence of heart failure in G51−75 (5.7 vs. 6.9%, P = 0.07).ConclusionThe thrombus aspiration neither significantly reduced the in-hospital incidence of major adverse cardiac events nor increased stroke risk. However, it might play a protective role in reducing in-hospital sudden cardiac arrest and increasing survival from cardiovascular death at 3 days for the elderly.

Effect of Coronary Thrombus Aspiration in Non ST Elevation Acute Coronary Syndrome Patients on Three-Year Survival- Does it add any Benefit?

We assessed the effect of thrombus aspiration (TA) during percutaneous coronary intervention (PCI) on in-hospital and 3-year mortality in consecutive non-ST segment elevation myocardial infarction (n = 189) and unstable angina pectoris (n = 148) patients (n = 337) between 2011 and 2016. In total, 153 patients (45.4%) underwent TA. The number of patients with postoperative thrombolysis in terms of myocardial infarction grade 3 blood flow (P < .001) and myocardial blush grade 3 (P < .001) were significantly higher in all TA groups. At 6-, 12- and 24-month post-PCI, the mean left ventricular ejection fraction was significantly higher in the all TA groups versus the stand alone PCI group (P < .001). Thrombus aspiration was associated with a significant improvement both in epicardial flow, myocardial perfusion and left ventricular ejection fraction. Thrombus aspiration during PCI in all acute coronary syndrome (except ST segment elevation) patients was associated with better survival compared with stand alone PCI group at 3-year follow-up (P = .019).

OR31. Effect of Selective Thrombus Aspiration on Clinical Outcomes in Patients with ST-Segment Elevation Acute Coronary Syndrome Undergoing Primary Percutaneous Coronary Intervention

Abstract Aims Manual thrombus aspiration (TA) can reduce distal embolization and improve microvascular perfusion in patients with ST-segment elevation acute coronary syndrome (STE-ACS), especially in patients with high thrombus burden. The aim of this study is to determine the effect of selective TA on clinical outcomes after primary PCI. Methods and Results A retrospective cohort study was performed on STE-ACS patients within 12 hours onset and initial TIMI Thrombus grade ≥3 undergoing primary PCI and selective TA in Dr. Kariadi General Hospital from January 2016 to December 2019. The measured clinical outcome was in-hospital MACE which consisted of mortality, cardiogenic shock, acute lung oedema, arrhythmia, urgent revascularization, and stroke. There were 196 patients fulfiling the criteria, consisted of 96 patients in TA group and 100 patients in non-TA group. Angiographic success in TA group was 97.9%. TA group achieved a better reduction of TIMI thrombus than in non-TA group (4.31 vs 4.11, p = 0.012). There were 15 patients in TA group (15.6%) and 20 patients in non-TA group (20%) who experienced in-hospital MACE after primary PCI (RR 1.055, 95% CI 0.926-1.202, p = 0.424). In patients with initial TIMI Thrombus grade 5, MACE in TA group occurred less than non-TA group (13.2% vs 42.9%, p = 0.01). Conclusions Selective TA did not affect in-hospital MACE after primary PCI. In patients with initial TIMI Thrombus Grade 5, TA might be beneficial to reduce MACE after primary PCI.

Manual Thrombus Aspiration and its Procedural Stroke Risk in Myocardial Infarction.

BackgroundThe previous large‐scale randomized controlled trial showed that routine thrombus aspiration (TA) during percutaneous coronary intervention (PCI) was associated with an increased risk of stroke. However, real‐world clinical evidence is still limited.Methods and ResultsWe investigated the association between manual TA and stroke risk during primary PCI in the OACIS (Osaka Acute Coronary Insufficiency Study) database (N=12 093). The OACIS is a prospective, multicenter registry of myocardial infarction. The primary end point of the present study is stroke at 7 days. A total of 9147 patients who underwent primary PCI within 24 hours of hospitalization were finally analyzed (TA group, n=4448, versus non‐TA group, n=4699 patients). TA was independently associated with risk of stroke at 7 days (odds ratio [OR], 1.92 [95% CI, 1.19‒3.12]; P=0.008) in the simple logistic regression model, while the multilevel random effects logistic regression model with hospital treated as a random effect showed that manual TA was not associated with incremental risk of stroke at 7 days (OR, 0.91 [95% CI, 0.71‒1.16]; P=0.435). The 7‐day stroke risk of manual TA was significantly heterogeneous in different institutions (P for interaction=0.007).ConclusionsManual TA during primary PCI for patients with acute myocardial infarction was independently associated with the overall increased risk of periprocedural stroke. However, this result was substantially skewed because of institution specific risk variation, suggesting that the periprocedural stroke may be preventable by prudent PCI procedure or appropriate periprocedural management.RegistrationURL: https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000005464. Unique identifier: UMIN000004575.

Effect of thrombus aspiration on microcirculatory resistance and ventricular function in patients with high thrombus burden

BackgroundStudies have not demonstrated consistent outcomes following thrombus aspiration in Primary Percutaneous Coronary Intervention (PPCI). We investigated the relationship between thrombus aspiration and microvascular obstruction as measured using Index of Microcirculatory Resistance (IMR) immediately following PPCI and Left Ventricle Function Improvement measured using Global Longitudinal Strain (GLS) six months following PPCI. Our aim is to determine microvascular obstruction and left ventricle function improvement six months following thrombus aspiration during PPCI.MethodsThis was a single-center, observational, prospective non-randomized study involving 45 patients with thrombus score 4–5 (defined as high thrombus burden) and Thrombolysis in Myocardial Infarction (TIMI) flow of 0–2 who subsequently underwent PPCI. Thrombus aspiration was conducted based on physician discretion. The IMR was measured immediately following the procedure. All patients underwent echocardiography to measure GLS at 24 h, 3 months and 6 months following PPCI.ResultsThirty-three (73%) patients underwent thrombus aspiration during PPCI and twelve (27%) patients underwent the conventional PPCI. No significant difference in IMR was found between the group that underwent thrombus aspiration and the group that underwent conventional PCI (51.9 ± 41.5 vs 47.1 ± 35.6 p = 0.723). TIMI flow after PPCI was worse in thrombus aspiration group (OR 5.2 [1.2–23.2], p = 0.041). There was no difference in GLS between two groups at 6-month follow-up (− 13.0 ± 3.4 vs − 12.8 ± 4.6, p = 0.912).ConclusionThis study indicates no benefit of thrombus aspiration during PPCI in reducing either microvascular obstruction or left ventricular function at 6-month follow-up for patients with high thrombus burden. Nevertheless, further studies are required before definite conclusions can be made.

Long-term Impact of Thrombus Aspiration in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) is reported to improve myocardial reperfusion. However, the long-term prognostic implication of TA remains unclear. We aimed to investigate the influence of adjunctive TA on long-term outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing PPCI. All STEMI patients from China that included in the TOTAL trial who were ≥18 years old and referred for PPCI within the 12 hours after symptom onset between January 2011 and November 2012 were retrospectively analyzed. Patients were divided into 2 groups based on the use of TA or not. The primary efficacy outcomes were 5-year major adverse cardiac events, a composite of cardiovascular death, recurrent MI, cardiogenic shock, or heart failure hospitalization. The primary safety outcome was a 5-year stroke. A total of 563 patients were included. The incidence rate of major adverse cardiac events at 5 years in the TA group was similar to that in the PCI group (hazard ratio [HR] 0.70; 95% confidence interval [CI] 0.42 to 1.17). In addition, TA was significantly associated with a nearly sevenfold increased risk of stroke at 5 years compared with PCI alone (HR 7.32, 95% CI 1.33 to 40.31). Our propensity scoring match analyses suggested that patients with an occluded lesion might benefit from the TA (HR 0.24, 95% CI 0.08 to 0.70). In conclusion, TA is not associated with improved outcomes in patients with STEMI but may have an adverse impact on stroke. Patients with an occluded infarct-related artery could benefit from the TA.

COMPARISON OF MANUAL THROMBUS ASPIRATION WITH DIRECT STENTING IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AND TOTALLY OCCLUDED CULPRIT ARTERIES

The aimof this study was to evaluate the efficacy and safety of the manual thrombus aspiration in comparison with direct stenting in patients with ST-segment elevation myocardial infarction (STEMI) and totally occluded culprit arteries.Material and Methods. Data were collected from the hospital database, which contained information about 1297 patients with STEMI who were admitted to the coronary care unit and underwent primary percutaneous coronary interventions. A total of 227 patients with totally occluded culprit arteries and partially or completely restored blood flow after wiring were included in the analysis. Altogether 25 patients after manual thrombus aspiration were compared with 202 patients after direct stenting. The groups were comparable by gender and age, and by the main clinical and angiographic characteristics.Results.There were no differences in in-hospital outcomes. In the thrombus aspiration group, the rate of no-reflow phenomenon was higher insignificantly (8 vs 3.5%, р=0.259). There were no incidences of death and major adverse cardiac events in the thrombus aspiration group. No cases of stent thrombosis were registered in either of group.Conclusion. The manual thrombus aspiration strategy in comparison with direct stenting in patients with STEMI and totally occluded culprit artery was not associated with improved clinical and procedural in-hospital outcomes.

Effect of thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Objective: To investigate the effect of thrombus aspiration during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: This retrospective study included 321 STEMI patients who underwent PPCI at Beijing Chaoyang hospital from January 2013 to March 2014. Patients were divided into the PPCI group (189 cases) and the PPCI plus thrombus aspiration group (132 cases). Baseline and perioperative clinical data, procedural characteristics were collected, and primary endpoint events including all-cause death, re-myocardial infarction, and coronary revascularization and secondary endpoint events including cardiac death, recurrent angina, target lesion revascularization, and stent thrombosis were recorded during the follow-up. Results: There were no significant difference between PPCI group and PPCI plus aspiration group in age ((59.8±12.5) years old vs. (58.3±14.4) years old, P=0.060) and male ratio (82.5% (156/189) vs. 82.6% (109/132), P=0.993). The number of disease vessels (1.59±0.81 vs. 1.47±0.70, P=0.039) and the prevalence of left anterior descending as infarction related artery (52.3% (69/132) vs. 38.6% (73/189), P=0.022) were significantly higher in the PPCI plus aspiration group than that in the PPCI group.The symptom onset time (3.0 (2.0,4.8) hours vs. 4.0 (2.0,7.0) hours, P=0.027) and myocardial ischemia time (3.9 (2.7,6.2) hours vs. 4.7 (2.9,7.9) hours, P=0.022) were significantly in the PPCI plus aspiration group than in the PPCI group. The percent of thrombolysis in myocardial infarction (TIMI) thrombosis score≥ grade 4 (92.4% (122/132) vs. 75.1% (142/189), P<0.001)and postoperative TIMI flow grade 3 (70.5% (93/132) vs. 60.8% (115/189), P=0.003) was significantly higher in the PPCI plus aspiration group than in the PPCI group. The PPCI group patients were followed up for (31.6±7.5) months, and PPCI plus aspiration group patients were followed up for (32.2±6.7) months (P=0.466). During the follow-up period, there was no significant difference in the incidence of primary endpoint events between the PPCI plus aspiration group and the PPCI group (17.1% (22/129) vs. 16.9% (31/184), P=0.962). Recurrent angina was more frequent in the PPCI plus aspiration group than in the PPCI group (25.6% (33/129) vs. 16.3% (30/184), P=0.044). There was no significant difference in cardiac death (3.1% (4/129) vs. 3.3% (6/184), P=1.000), target lesion revascularization (3.9% (5/129) vs. 3.3% (6/184), P=0.765), and stent thrombosis (3.1% (4/129) vs. 2.7% (5/184), P=1.000) between the PPCI plus aspiration group and the PPCI group. Multivariate Cox regression analysis showed that the number of diseased vessels (RR=1.901, 95%CI 1.217-2.970, P=0.005) and postoperative TIMI flow grade (RR=0.455, 95%CI 0.221-0.934, P=0.032) were the risk factors for coronary revascularization after PPCI. The number of diseased vessels was a risk factor for major endpoint events after PPCI (RR=1.421, 95%CI 1.017-1.986, P=0.040). Conclusion: The incidence of clinical events is similar in patients with STEMI treated with PPCI alone or PPCI plus aspiration.

The relationship between visible thrombus aspiration material with no-reflow and in-hospital mortality ratio in patients with anterior ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

The benefit of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) is not yet fully clear. The aim of this study was to investigate the clinical impact of visible thrombus aspiration (VTA) material. A total of 295 patients with a Thrombolysis in Myocardial Infarction (TIMI) flow score of 0 or 1 after an anterior STEMI were included in the study. Manual TA devices were used before performing PCI. The patients were divided into 2 groups: (1) visible thrombus aspiration (VTA) group and (2) non-visible thrombus aspiration (non-VTA) group. No-reflow was defined as TIMI grade 0, 1, or 2 flow, or TIMI grade 3 with a myocardial blush of grade 0 or 1. The primary endpoint was the occurrence of no-reflow. VTA was retrieved in 178 (60.3%) of the patients. A no-reflow determination was significantly less frequent in the VTA group (p&lt;0.001). The ejection fraction and ST-segment resolution values were higher, and the in-hospital mortality, Killip class II-IV rating, and post-pPCI TIMI frame count were lower in the VTA group (p&lt;0.05 for each). VTA predicted a lower rate of in-hospital mortality and no-reflow in patients with anterior STEMI who underwent pPCI.

Impact of total ischemic time on manual thrombus aspiration benefit during primary percutaneous coronary intervention

The benefits of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) remain uncertain. We assessed the influence of total ischemic time (TIT) on clinical outcomes among STEMI patients undergoing manual TA during pPCI. We conducted a retrospective study of patients enrolled in the Acute Myocardial Infarction in Switzerland Plus registry. STEMI patients undergoing pPCI with (TA group) or without (PCI-alone group) manual TA were stratified based on short (<3 hours), intermediate (3-6 hours), and long (>6 hours) TIT. The primary endpoint was in-hospital all-cause mortality. The secondary endpoint was in-hospital major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction and stroke. Between 2008 and 2014, 4'154 patients (TA 48%) were included. Risk-adjusted in-hospital all-cause mortality was not different between TA and PCI-alone groups (OR 1.29; 95%CI 0.83-1.98; p=0.26), whereas there was significantly increased risk of MACE (OR 1.52; 95%CI 1.05-2.19; p=0.03) in patients treated with manual TA compared with PCI-alone. There was no significant difference between manual TA and PCI-alone with respect to risk-adjusted all-cause mortality according to TIT groups, but risk-adjusted MACE rates were significantly higher in the group of patients with long TIT treated with manual TA compared with PCI-alone (OR 2.42; 95%CI 1.16-5.04; p=0.02). In a large registry of STEMI patients, manual TA was not associated with lower risk-adjusted in-hospital all-cause mortality compared with PCI-alone regardless of TIT but was associated with significantly greater risk of MACE. In patients with prolonged TIT, manual TA was associated with higher risk-adjusted MACE rates compared with PCI-alone.

Effect of Selective Thrombus Aspiration on Serum Lipoprotein-Associated Phospholipase A2 in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention with High Thrombus Burden.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a potential therapeutic target in acute coronary syndromes. Although recent evidence does not support the routine use of manual thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), the use of TA is associated with a significant improvement in myocardial reperfusion, especially in patients with high thrombus burden (HTB). We hypothesized that TA would reduce the serum Lp-PLA2 levels in STEMI patients undergoing PPCI with HTB. Our study cohort included 320 consecutive STEMI patients undergoing PPCI with HTB who were randomly assigned to receive either TA before PPCI (TA group, n = 160) or PPCI alone (standard PPCI group, n = 160). The baseline characteristics of study participants were well-matched. After 30 ± 2 days, serum Lp-PLA2 levels decreased by 53.9% in the TA group (152.9 ± 58.1 ng/mL) and decreased by 31.2% in the standard PPCI group (84.2 ± 86.6 ng/mL, p < 0.001). The TA group had a significantly lower prevalence of balloon predilatation, number of stents used, total stent length and corrected thrombolysis in myocardial infarction frame count, and a higher percentage of myocardial blush grade ≥ 2 compared with the standard PPCI group (all p < 0.001). No significant difference between the groups was observed in 30 ± 2 days for major adverse cardiovascular and cerebrovascular events (p = 0.702). After 30 ± 2 days of treatment, TA may significantly reduce serum levels of Lp-PLA2 in STEMI patients undergoing PPCI with HTB.

MYOCARDIAL REPERFUSION IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN THE USE OF MANUAL THROMBUS ASPIRATION

Objective: to determine the efficiency and safety of manual thrombus aspiration (TA) in patients with acute ST-segment elevation myocardial infarction. Material and methods. The investigation enrolled 200 patients with ST-segment elevation myocardial infarction. According to prehospital therapy, all the patients were divided into life-saving (n = 100) percutaneous coronary intervention (PCI) (lsPCI) and primary (n = 100) PCI (pPCI) groups. After coronary angiography the patients were randomized into manual TA (n = 50) and non-manual TA (n = 50) groups. The endpoints took into consideration myocardial reperfusion and the impact of TA on immediate results and in-hospital prognosis. Results. The pPCI subgroup with TA as compared to the non-TA subgroup more commonly achieved TIMI-3 flow (82 and 54%, respectively; p = 0.003) and myocardial blush grade 3 or 4 (60 and 36%, respectively, p = 0.016). ECG also showed the achievement of the indirect signs of infarct-related artery reperfusion (pPCI + TA, 44%; and pPCI – TA, 76%; p = 0.001). On the contrary, in the lsPCI group, the best antegrade blood flow was recorded in the non-manual TA patients, as shown by both the TIMI scale (48 and 70%, respectively; p = 0.025) and the myocardial blush grade (24 and 50%, respectively, p=0,007). A larger number of patients from the non-TA subgroup were noted to have a decrease in the ST segment, as evidenced by ECG (slPCI + TA, 34% and slPCI – TA, 54%; p = 0.044). Conclusion. According to angiographic and electrocardiographic findings, coronary blood flow effectively restored in the pPCI + TA group while manual TA did not show any advantages over routine PCI in the slPCI group.

Outcome of thrombus aspiration in STEMI patients: a propensity score-adjusted study.

The use of thrombus aspiration (TA) prior to primary percutaneous coronary intervention (PPCI) has undergone a radical change in intervention guidelines. The clinical implications, however, are still under scrutiny. This study investigated the clinical effects and outcome of TA before PPCI in patients with ST-segment elevation myocardial infarction (STEMI). Overall 1027 patients with STEMI were analyzed in this retrospective, propensity score-adjusted, multicenter study. The primary endpoints were in-hospital and long-term mortality. There were 418 patients in the TA group and 609 in the conventional PPCI group. The in-hospital mortality rate was significantly higher in the TA group (8.7 vs. 5.0%; P = 0.03). During long-term follow-up [median follow-up duration 689 days (IQR 405-959)] the mortality rates were similar (TA 14.3%, conventional PPCI 15.0%; P = 0.85). Survival analysis for the complete observation period revealed no significant benefit of TA [hazard ratio (HR) 1.12; 97.5% CI 0.90-0.71; P = 0.63]. There were also no significant differences between the groups in the following secondary endpoints: composite of cardiovascular death and non-fatal reinfarction at discharge (P = 0.39), post-PPCI thrombolysis in myocardial infarction flow-grade-3 (P = 0.14), left ventricular ejection fraction (P = 0.47), and non-fatal reinfarction during follow-up (P = 0.17). Rehospitalization rate (1.82 vs. 10.3%; P < 0.0001) and Canadian Cardiovascular Society (CCS) grading (P = 0.02) during follow-up were significantly lower in the TA group. In our cohort the in-hospital mortality rate was significantly higher for TA patients, but during long-term follow-up the mortality rates did not differ. The incidence of rehospitalization and CCS grading were lower in the TA-treated patients.

Circadian dependence of manual thrombus aspiration benefit in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

The clinical benefit of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. This study assessed the impact of circadian rhythms on the effectiveness of manual TA. We conducted an observational study of patients enrolled in the Acute Myocardial Infarction in Switzerland Plus registry. STEMI patients undergoing PPCI with (TA group) or without (PCI-alone group) manual TA were divided based on time-of-day symptom onset: group 1 (00:00-05:59), group 2 (06:00-11:59), group 3 (12:00-17:59) and group 4 (18:00-23:59). The primary endpoint was circadian variation of myocardial infarction (MI) size. The secondary endpoint was in-hospital all-cause mortality. Between 2009 and 2014, 3648 patients underwent PPCI (TA, 49%). After propensity-score matching, 2860 patients were included. Minimal myocardial Injury was observed in groups 2 and 3 (peak creatine kinase level group 1, 2723 ± 148U/l; group 2, 2493 ± 105U/l; group 3, 2550 ± 106U/l; group 4, 2952 ± 144 U/l; p = 0.044) in the TA group, whereas no time-of-day dependence was found in PCI-alone group. After periodic sinusoidal regression analysis, a circadian relationship between time-of-day symptom onset and MI size was demonstrated in the TA group (p < 0.001). In-hospital all-cause mortality was 3.4% in the TA group and 4.3% in the PCI-alone group (p = 0.20). In this large registry of STEMI patients, manual TA did not reduce in-hospital all-cause mortality. Nonetheless, there was a circadian dependence of TA effectiveness with greatest myocardial salvage for patients with symptom onset between 06:00 and 17:59.