Abstract 13271: Prognostic Role of Thrombus Aspiration and Glycoprotein IIb/IIIa Inhibitors During Primary Percutaneous Coronary Intervention
Background. The beneficial role of adjunctive antithrombotic treatments, such as manual thrombus aspiration (TA) and glycoprotein IIb/IIIa inhibitors (GPI) was previously confirmed in the setting of Primary Primary Percutaneous Coronary Intervention (PPCI). Still, trials regarding GPI did not consider patients undergoing TA, while all major studies on TA concerned patient populations prevalently treated with GPI.
Aim. We sought to investigate the individual impact of each treatment in a real-world ST-elevation myocardial infarction (STEMI) patient population.
Materials and methods. From January 2007 to December 2009, 448 STEMI patients were consecutively enrolled according to a 2×2 factorial design into 1 of the 4 groups: standard PPCI, PCI with thrombus aspiration (TA), PPCI with GPI infusion, and PPCI with both treatments (TA+GPI).
Results. A post procedural TIMI flow 2-3 was present in 91% in the standard PPCI group, 95% in the GPI group, 95% in the TA group, and 98.8% in the TA+GPI group (p=0.026). At 30 days of follow up, the cumulative incidence of death and re-infarction was 5% in patients treated TA and GPI, 10% in patients treated with only TA, 15% in patients treated only with GPI, and 16% in patients treated with standard PPCI (p=0.036). Long term mortality differed significantly between patients treated with both TA and GPI and patients treated with standard PPCI (7% vs 17.2%, p=0.012). At multivariate analysis, age (HR 1.058, CI 1.015-1.103, p=0.008), III-IV Killip Class (HR 12.663, CI 4.772-33.602, p<0.001), TA (HR 0.355, CI 0.138-0.914, p=0.032), left ventricular ejection fraction<45% (HR 4.787, CI 1.941-11.807, p=0.001), and increased CK-MB values (HR 1.002, CI 1-1.003, p=0.007) emerged as independent predictors for overall mortality.
Conclusions. In STEMI patients undergoing PPCI, the combined application of thrombus aspiration and abciximab was associated with lower short term mortality and reinfarction rates and with an improved long term outcome. TA, but not GPI, emerged as an independent predictor of long term survival.
- Glycoprotein iib/iiia platelet inhibitors
- Myocardial infarction, STEMI
- Percutaneous coronary intervention
- © 2011 by American Heart Association, Inc.