Background: The role of thrombus aspiration (TA) as an adjunct to percutaneous coronary intervention (PCI) remains a matter of controversy.
Objective: We investigated whether TA during PCI could add benefit to patients with acute ST-elevation myocardial infarction (STEMI).
Subjects and Methods: Of 2,795 patients with STEMI enrolled in the nationwide prospective Korea Working Group on Myocardial Infarction Registry between February 2008 and May 2009, a cohort of 429 patients (333 men, mean age 62±13) who underwent TA during PCI was compared with 429 propensity-matched patients (312 men, mean age 62±13) who underwent conventional PCI without TA after adjustment for bias in treatment assignment. In-hospital mortality and clinical outcomes at 30 days were assessed using Cox regression models.
Results: There were no differences between TA and non-TA groups in the use of high-dose clopidogrel loading (600 mg) (63.9% vs. 63.4%, p=0.943) and a glycoprotein IIb/IIIa inhibitor (38.5% vs. 38.5%, p=1.000), and in the rate of post-PCI TIMI III flow (88.3% vs. 86.5%, p=0.471). Stenting with drug-eluting stents were similar (85.5% vs. 85.8%, p=0.906), but the stent diameter was greater in TA group (3.3±0.4 mm vs. 3.1±0.4 mm, p<0.0005). Compared to non-TA group, TA group had lower left ventricular ejection fraction (49±11% vs. 53±11%, p<0.0005), higher serum levels of creatine kinase-MB (255±719 U/L vs. 152±157 U/L, p=0.005) and high-sensitivity C-reactive protein (9.2±27 ng/mL vs. 4.8±11 ng/mL, p=0.007), and they were less likely to receive cilostazol after PCI in addition to aspirin and clopidgrel (17.7% vs. 28.4%, p<0.0005). In-hospital death occurred in 5.1% and 4.4% of patients in each group (p=0.749). Cox regression analysis with adjustment for imbalances in prognostic factors showed no difference in the rates of death, myocardial infarction, and stent thrombosis at 30 days.
Conclusion: TA during primary PCI for acute STEMI was applied in patients with greater infarct size and reduced the need for an additional use of cilostazol. However, it failed to improve short-term clinical outcomes.
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