Abstract 4504: Adjunctive Thrombus Aspiration in Primary Percutaneous Coronary Intervention in Real-world Patients With St-elevation Myocardial Infarction
Recent randomized trials have shown significant clinical benefit of adjunctive thrombus aspiration (TA) in ST-elevation myocardial infarction (STEMI). We aimed at prospectively assessing the effect of TA in real-world STEMI patients (pts) undergoing primary percutaneous coronary intervention (PCI).
Methods. We included 313 STEMI pts undergoing (within 12 hours from onset of symptoms) primary PCI with TIMI Flow Grade 0 or 1 in the infarct related artery at baseline angiogram. Following the strategy adopted (left at operator’s discretion), pts were divided into: thrombus aspiration (TA) and conventional PCI (cPCI) group. Procedural and long-term clinical outcomes were compared between the two groups.
Results. Adjunctive TA was adopted in 194 (62%) pts, while 119 pts underwent cPCI. Baseline characteristics were similar between groups. TA was associated with significantly lower post-PCI TIMI frame count values (19±15 vs. 25±17; p=0.002) and higher TIMI Flow Grade 3 (92% vs. 73%; p<0.001) as compared to cPCI. Post-procedural myocardial perfusion assessed by myocardial blush grade (MBG) was significantly increased in TA group (MBG 3: 44% vs. 21%; p<0.001). No significant difference was found between the two groups in clinical outcome at 30 days. At 1-year, patients treated with TA showed significantly higher overall survival (log-rank p=0.017) and MACE-free survival (log-rank p=0.018).
Conclusions. In real-world STEMI pts with an occluded infarct-related artery, adjunctive thrombus aspiration improves coronary flow, myocardial perfusion, and long-term clinical outcome as compared with conventional PCI.
These findings confirm recent randomized studies and support the use of thrombus aspiration during primary PCI also in a real-world patient population.