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Manual thrombus aspiration is not associated with reduced mortality in patients treated with primary percutaneous coronary intervention: An observational study of 10,929 patients with ST-segment elevation myocardial infarction from the London heart attack group

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Daniel A. Jones, Krishnaraj S. Rathod, Sean Gallagher, Ajay K. Jain, Sundeep Singh Kalra, Pitt Lim, Tom Crake, Mick Ozkor, Roby Rakhit, Charles J. Knight, M. Bilal Iqbal, Miles C. Dalby, Iqbal S. Malik, Mark Whitbread, Anthony Mathur, Simon Redwood, Philip A. MacCarthy, Roshan Weerackody, Andrew Wragg

Original languageEnglish
Pages (from-to)575-584
Number of pages10
JournalJacc-Cardiovascular Interventions
Volume8
Issue number4
DOIs
Publication statusPublished - 20 Apr 2015

King's Authors

Abstract

Objectives

This study aimed to assess the impact of thrombus aspiration on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI).

Background

The clinical effect of routine intracoronary thrombus aspiration before primary PCI in patients with ST-segment elevation myocardial infarction is uncertain.

Methods

We undertook an observational cohort study of 10,929 ST-segment elevation myocardial infarction patients from January 2005 to July 2011 at 8 centers across London, United Kingdom. Patients’ details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society PCI dataset. Primary outcome was all-cause mortality at a median follow-up of 3.0 years (interquartile range: 1.2 to 4.6 years).

Results

In our cohort, 3,572 patients (32.7%) underwent thrombus aspiration during primary PCI. Patients who had thrombus aspiration were younger, had lower rates of previous myocardial infarction but were more likely to have poor left ventricular function. Procedural success rates were higher (90.9% vs. 89.2%; p = 0.005) and in-hospital major adverse cardiac event rates were lower (4.4% vs. 5.5%; p = 0.012) in patients undergoing thrombus aspiration. However, Kaplan-Meier analysis demonstrated no significant difference in mortality rates between patients with and without thrombus aspiration (14.8% aspiration vs. 15.3% PCI only; p = 0.737) during the follow-up period. After multivariate Cox analysis (hazard ratio [HR]: 0.89, 95% confidence interval [CI]: 0.65 to 1.23) and the addition of propensity matching (HR: 0.85 95% CI: 0.60 to 1.20) thrombus aspiration was still not associated with decreased mortality.

Conclusions

In this cohort of nearly 11,000 patients, routine thrombus aspiration was not associated with a reduction in long-term mortality in patients undergoing primary PCI, although procedural success and in-hospital major adverse cardiac event rates were improved.

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