Abstract 4690: Impact of Thrombus Aspiration in Patients With STEMI Undergoing Primary PCI: Analysis From the HORIZONS-AMI Trial
Objective: We compared epicardial flow, ST-segment resolution and clinical outcomes after primary PCI in STEMI performed with and without use of a “simple” aspiration catheter, and assessed the role of contemporary antithrombotic strategies in patients treated with thrombus aspiration.
Methods and Results: In the HORIZONS-AMI trial, at operator discretion, catheter-based thrombus aspiration prior to PCI was performed in 318 of 3233 pts (9.8%). The use of thrombus aspiration correlated with younger age, current smoking, prior history of PCI, higher incidence of thrombus on the baseline angiogram, higher rates of direct stenting and post stent dilatation. By core lab analysis, during the procedure pts with vs without thrombus aspiration had higher rates of distal embolization (9.0% vs. 3.2%, p<0.0001) and slow flow (5.3% vs. 3.4%, p=0.06) but not of dissection (6.6% vs. 5.3%, p=0.32). There were no significant differences in the rates of complete (>70%) STR at 60 min post procedure (48.2% vs. 50.3%, P=0.51). Pts with vs without thrombus aspiration had similar rates of 30-day MACE (death, reinfarction, TVR or stroke; 4.7% vs. 4.2%, p=0.68) but higher rates of major bleeding (8.5% vs. 6.3%, p=0.13). There were no significant interactions between randomized antithrombin regimen (bivalirudin monotherapy vs. heparin + glycoprotein IIb/IIIa inhibition) and performance of thrombus aspiration on either TIMI-3 flow, 60 minute STR, or 30 day MACE (p for interaction=0.81, 0.68 and 0.62 respectively).
Conclusion: Pts treated with thrombus aspiration prior to PCI compared to conventional PCI in the HORIZONS-AMI trial had similar rates of final TIMI flow grade 3 and higher rates of angiographic complications, with similar rates of complete STR and 30-day MACE. Adjunctive antithrombotic therapy regimen had no significant impact on the outcomes of thrombus aspiration.