Published Online
on October 13, 2008

A more recent version of this article appeared on October 28, 2008

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Submitted on March 19, 2008
Accepted on August 29, 2008

Presence of Older Thrombus Is an Independent Predictor of Long-Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Thrombus Aspiration During Primary Percutaneous Coronary Intervention

Miranda C.A. Kramer MD, Allard C. van der Wal MD, PhD, Karel T. Koch MD, PhD, Johanna P.H.M. Ploegmakers BSc, René J. van der Schaaf MD, José P.S. Henriques MD, PhD, Jan Baan Jr MD, PhD, Saskia Z.H. Rittersma MD, PhD, Marije M. Vis MD, Jan J. Piek MD, PhD, Jan G.P. Tijssen PhD, and Robbert J. de Winter MD, PhD^*

From the Departments of Cardiology (M.C.A.K., K.T.K., R.J.v.d.S., J.P.S.H., J.B., S.Z.H.R., M.M.V., J.J.P., J.G.P.T., R.J.d.W.) and Pathology (A.C.v.d.W., J.P.H.M.P.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

^* To whom correspondence should be addressed. E-mail: r.j.dewinter{at}amc.uva.nl.

Background—Routine thrombus aspiration is frequently used during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction to prevent distal embolization. Recently, evidence of clinical benefit was published. In 50% of the ST-elevation myocardial infarction patients with an onset of symptoms <12 hours before, thrombi were shown to be >1 day old. This observation illustrates that plaque rupture and coronary occlusion are significantly separated in time. In the present study, we correlate the presence of fresh versus older thrombus with long-term mortality.

Methods and Results—Thrombus aspiration was performed in 1315 patients treated with primary percutaneous coronary intervention with 3 devices (Rescue, Export, and Proxis). Aspirated material was fixed in formalin and processed for histopathology. If possible, thrombus age was classified as either fresh only (<1 day) or older (>1 day). We identified fresh thrombus in 552 patients and older thrombus in 372 patients. The cumulative Kaplan-Meier estimate of all-cause mortality at 4 years was significantly higher in patients with older thrombus (16.0%) compared with patients with fresh thrombus (7.4%), with a hazard ratio of 1.82 (95% confidence interval, 1.17 to 2.85; P=0.008). Multivariate analysis identified the presence of older thrombus, in addition to other established predictors, as an independent predictor (hazard ratio, 1.83; 95% confidence interval, 1.14 to 2.93; P=0.01) of long-term mortality.

Conclusion—Our study demonstrates that the presence of older thrombus, in addition to other established predictors, is an independent predictor of long-term mortality in patients with ST-elevation myocardial infarction treated with thrombus aspiration during primary percutaneous coronary intervention.

Key words: angioplasty • follow-up studies • myocardial infarction • pathology • thrombosis

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