Abstract 14590: Thrombus Aspiration and its Affect on Efficacy and Safety of Drug Eluting Stents in Acute Myocardial Infarction.
Aim Thrombus aspiration (TA) in myocardial infarction (STEMI) showed favourable clinical outcome in the TAPAS trial for patients treated with bare metal stents. We aimed to determine whether TA in primary percutaneous coronary intervention (PPCI) in which DES are implanted results in improved survival, MACE and stent thrombosis (ST) at 1.5 years follow-up.
Methods/Results: Between November 2006 and Nov. 2008, 1007 consecutive patients undergoing PPCI with exclusive use of DES were prospectively followed up. TA use in this time period changed from 0% initially to 59% most recently. Patients were divided into those with TA (n=265) and those without TA (n=742). A trend towards lower mortality was observed in TA group (HR 0.70, 95% CI 0.45–1.01, p=0.11). No difference was observed in other endpoints. After propensity matching with clinical (also including TIMI risk score variables) and angiographic (also incl. TIMI flow and thrombus grade-TG) characteristics, TA significantly improved survival (propensity adjusted HR 0.45, 95% CI 0.26–0.79 p <0.01) with a trend towards a reduction in MACE (propensity adjusted HR 0.70, 95% CI 0.43–1.12, p=0.14). TLR, TVR and angiographic definite ST were more common in the TA group when compared to the matched non-TA group (fig.1). Subgroup analysis shows that the benefit of TA tends to be higher in those with TIMI 0/1, high TG, in vessels other than LAD, and for DES other than everolimus eluting stents. (fig. 2)
Conclusions: Thrombus aspiration in patients having DES implantation for acute STEMI improves stent safety endpoints by a reduction in mortality at 1.5 years of follow-up. TA however does not seem to influence positively efficacy endpoints of DES.
- © 2010 by American Heart Association, Inc.